CommercialReimbursementMedium impact
Blue Cross and Blue Shield of Alabama Complies with New Pharmacy Law
Blue Cross Blue Shield of Alabama·AL · Pharmacy·Provider News
Effective date
Oct 1, 2025
We identified it
Oct 1, 2025
Summary
Effective October 1, 2025, Blue Cross and Blue Shield of Alabama is complying with the Alabama Community Pharmacy Relief Act, which changes how Pharmacy Benefit Managers reimburse community pharmacies. Reimbursement will now be based on the Alabama Medicaid rate (drug cost plus dispensing fee). Patient copays remain unchanged, and out-of-pocket costs will not exceed the designated copay amount. This affects prescription processing and pharmacy claims for non-Medicare commercial plans in Alabama.
Action Required
By October 1, 2025: Billing team must monitor pharmacy claim adjudication for Blue Cross and Blue Shield of Alabama commercial (non-Medicare) plans to ensure copays are correctly applied as the lesser of the designated copay or the actual drug cost. Verify that claims are being processed under the new Alabama Medicaid-based reimbursement methodology. Front desk and patient financial services staff should be prepared to explain to patients that copay amounts have not changed despite pharmacy reimbursement rate changes. No system configuration changes appear necessary since copay logic remains: patients pay the lesser of copay or cost. Confirm with BCBS of Alabama that Medicare Advantage and Traditional Medicare claims are unaffected. If billing software generates adjustment reports, review for any anomalies in pharmacy claim processing during October 2025.