Pharmacy Program
- Pharmacy Program Value
- Retail Pharmacy Program—Standard & Basic Options
- Mail Service Pharmacy Program—Standard Option Only
- Specialty Pharmacy Benefits
Save More
Save more with our Generic Drug Incentive Program
. Switch from brand-name to generic drugs and coinsurance and/or copayment amounts less than that for brand-name drugs for both Standard and Basic Option members. And get your first four refills free!
With this program, we will waive the coinsurance or copayment for the first four prescription fills when you switch from certain brand-name drugs to specific generic drugs. The average savings under the Generic Incentive Program is $30 to $60 per prescription fill or refill.
60, 000 Retail Pharmacies
There are more than 60,000 Preferred Network retail pharmacies nationwide along with our Internet Pharmacies. You can locate a Preferred retail pharmacy near you by calling 1-800-624-5060 or by accessing the Provider Directory
. If you have a question about the Retail Pharmacy Program, you can call 1-800-624-5060 to talk to one of our member service representatives.
More Choices, More Value
Your budget can take a hit when you need prescription drugs to manage a chronic condition or a one-time illness. Blue Cross and Blue Shield gives you more choices and more value with our pharmacy programs.
Standard Option members can choose the mail service program or the retail pharmacy program and Basic Option members can utilize the nationwide Preferred retail pharmacies to fill their prescriptions for the lowest possible cost available in the program.
Retail Pharmacy Program—Standard & Basic Options
As a Standard Option member, you can use your local Preferred or non-Preferred retail pharmacy, or use an Internet pharmacy. Basic Option members can use local Preferred retail pharmacies or our Internet pharmacies to obtain medications. For both options, just show your Service Benefit Plan ID card at a Preferred pharmacy, and you’ll receive Preferred prices on covered medications and supplies. There are no deductibles to meet. You pay only your appropriate coinsurance or copayment amount for each prescription or refill.
| What You Pay—Standard Option | What You Pay—Basic Option |
|---|---|
Up to a 90-day supply when you use Preferred Pharmacies or Internet Pharmacies. Nothing for the first four prescription fills or refills when you switch from certain brand-name drugs to specific generic drugs. Tier 1: 20% PPA for generic drugs. If Medicare Part B is your primary payer, you pay 15% PPA. Tier 2: 30% PPA for Preferred brand-name drugs. Tier 3: 45% PPA for non-Preferred brand-name drugs. | Up to a 34-day supply when you use Preferred Pharmacies or Internet Pharmacies. Tier 1: $10 copayment for generic drugs. Tier 2: $40 copayment for Preferred brand-name drugs. Tier 3: 50% or $50 minimum for non-Preferred brand-name drugs. |
Mail Service Pharmacy Program—Standard Option Only
The Mail Service Prescription Drug Program for Standard Option is an easy way to obtain those medications you take every day to treat chronic conditions such as high cholesterol or diabetes. It also gives you the convenience of home delivery. You pay one copayment per prescription or refill for up to a 90-day supply, as prescribed by your doctor. This benefit is not available under Basic Option.
| What You Pay—Standard Option | What You Pay—Basic Option |
|---|---|
You pay nothing for the first four prescription fills or refills when you switch from certain brand-name drugs to specific generic drugs. Up to a 90-day supply when you use Preferred Pharmacies or Internet Pharmacies. Nothing for the first four prescription fills or refills when you switch from certain brand-name drugs to specific generic drugs. Tier 1: $15 copayment for generic drugs. If you have Medicare Part B as your primary coverage, you pay a $10 copayment. Tier 2: $70 each for the first 30 Preferred brand-name drug prescriptions fills or refills, $50 copayment thereafter. Tier 3: $95 each for the first 30 non-Preferred brand-name drug prescriptions, $50 copayment thereafter. | No Benefit |
Specialty Pharmacy Benefits are provided through Tier 4 of our pharmacy benefits.
| What You Pay—Standard Option | What You Pay—Basic Option |
|---|---|
Under Standard Option, you pay an $80 copayment for Tier 4 (specialty) drugs purchased through our Specialty Drug Pharmacy Program. If you purchase specialty drugs at a retail pharmacy, you pay a 30% coinsurance amount. | Basic Option members can also use the Specialty Pharmacy through Tier 4 benefits. You pay a $40 copayment for a 34-day supply or $120 for a 90-day supply. For specialty drugs purchased at a Preferred retail pharmacy, you pay a $50 copayment for a 34-day supply or $150 for a 90-day supply. |
Page last updated: January 04, 2012