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Horizon BCBS Switches Prescription Processor to Express Scripts

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  Published in Politics and Government on Sunday, February 8th 2026 at 7:22 GMT by Patch
      Locales: New Jersey, UNITED STATES

Sunday, February 8th, 2026 - A significant shakeup in prescription drug coverage is looming for approximately 850,000 members of Horizon Blue Cross Blue Shield of New Jersey. The insurer has announced that CVS Caremark will no longer process prescriptions for Horizon members, transitioning those services to Express Scripts. This change, while intended to improve overall service in the long run, presents a logistical challenge for a large segment of the New Jersey population, requiring proactive steps to ensure uninterrupted access to vital medications.

The decision stems from the expiration of a contract between Horizon BCBS and CVS Caremark. While the exact reasons behind the non-renewal haven't been fully detailed publicly, industry analysts suggest that cost considerations and the desire for a broader range of services likely played a role. Express Scripts, a major pharmacy benefit manager (PBM), is positioned to offer Horizon a potentially more comprehensive and cost-effective solution.

However, the transition won't be seamless. Members will need to actively transfer their prescriptions to avoid disruptions in their medication schedules. Horizon BCBS has outlined a phased rollout to manage the volume of transfers, categorizing members based on the last digit of their plan number. This staggered approach aims to prevent overwhelming either Express Scripts or Horizon's customer service lines.

Detailed Phase Rollout:

• Phase 1 (February 15, 2026): Members whose Horizon plan numbers end in 0, 1, 2, 3, 4, 5, 6, 7, or 8 are the first to be affected. These members must begin the prescription transfer process by this date.
• Phase 2 (April 15, 2026): The second wave of affected members includes those with plan numbers ending in 0, 1, 2, 3, or 4. A slight overlap exists between Phase 1 and Phase 2, indicating a need for Horizon to efficiently handle the influx of transfer requests.
• Phase 3 (May 15, 2026): All remaining Horizon BCBS of New Jersey members will need to transfer their prescriptions by this final date, completing the full transition.

What Does This Mean for Affected Members?

Horizon BCBS is strongly urging affected members to take immediate action. Simply put, if you are a Horizon member and receive prescriptions regularly, you will need to transfer them. Waiting until the last minute could lead to delays in receiving essential medications. The insurer is promising to send direct communication to all impacted members, detailing the transfer process. This communication will likely include instructions on how to register with Express Scripts and submit prescription requests.

Beyond Simply Transferring Prescriptions: Potential Impacts and Considerations

This transition goes beyond just changing a service provider. It could potentially affect several aspects of a member's pharmacy experience. Members may encounter:

• Changes in Formulary: Express Scripts utilizes its own formulary (a list of covered drugs). While Horizon has assured members they are working to ensure continuity of coverage, some medications might require prior authorization or have different cost-sharing arrangements under the new PBM.
• Network Differences: The pharmacy network offered by Express Scripts may differ from that of CVS Caremark. Members should verify that their preferred pharmacies are included in the Express Scripts network to avoid potential issues.
• Mail-Order Pharmacy Adjustments: Members currently using CVS Caremark's mail-order pharmacy will need to re-enroll with Express Scripts' mail-order service if they wish to continue receiving medications via mail.
• Digital Account Updates: Members will need to create new accounts on the Express Scripts website or mobile app to manage their prescriptions, track claims, and access other services.

Horizon BCBS Resources and Support

Horizon BCBS has dedicated a section of its website ([ https://www.horizonbcbs.com/ ]) to provide comprehensive information about the transition. Members are encouraged to visit the site for FAQs, step-by-step instructions, and contact information for assistance. The insurer has also promised to bolster its customer service capacity to handle the anticipated increase in calls and inquiries.

Industry Trends and Future Implications

The shifting landscape of pharmacy benefit management highlights a broader trend within the healthcare industry: the consolidation of services and the ongoing pursuit of cost containment. PBMs play a crucial role in negotiating drug prices, managing formularies, and processing prescription claims. The competition between major PBMs like CVS Caremark and Express Scripts often results in changes to prescription coverage for health plan members.

This transition serves as a reminder for all healthcare consumers to stay informed about changes to their benefits and proactively manage their health information. With approximately 850,000 New Jersey residents impacted, a smooth and efficient transfer process is vital to ensuring continued access to necessary medications.