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Prescription Drugs

See how your Service Benefit Plan coverage works with different types of prescription drugs.

Helping you understand your prescription costs

The formulary is a list of our covered prescription drugs, including generic, brand name and specialty drugs.

See how we help keep your out-of-pocket costs low for the medications you and your family need.

 

Formularies

2020 Standard Option Formulary

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2020 Basic Option Formulary

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2020 FEP Blue Focus Formulary

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You can find the new 2021 formularies here.

Drug tiers

We organize our covered prescription drugs into tiers. The amount you pay for a drug depends on the tier it’s in. In general, the lower the drug tier the more cost effective the drug.

For Standard Option and Basic Option, you will generally pay the lowest cost share for any Tier 1 generic drug or Tier 4 Preferred specialty drug. If your drug is in Tier 2, Tier 3 or Tier 5, see if there’s a generic or Preferred drug alternative available and discuss these options with your healthcare provider.

With FEP Blue Focus, you will generally pay the lowest cost share for any Tier 1 generic drug. If your drug is in Tier 2 or not covered, see if there’s a generic or Preferred drug alternative available and discuss these options with your healthcare provider.

Standard & Basic Option

Tier 1:
Generic Drugs

Typically the most affordable drug type, and are equal to their brand name counterparts in quality, performance characteristics and intended use.

Tier 2:
Preferred Brand Name Drugs

Proven to be safe, effective, and favorably priced compared to Non-preferred brands. Cheaper than Non-preferred brands but more expensive than generics.

Tier 3: 
Non-preferred Brand Name Drugs

Proven to be safe and effective. Typically have a higher cost because these drugs have either a generic or Preferred brand available.

Tier 4:
Preferred Specialty Drugs

Used to treat complex health conditions. Proven to be safe, effective, and favorably priced compared to Non-preferred specialty drugs.

Tier 5:
Non-preferred Specialty Drugs

Typically have a higher cost because these drugs have a Preferred specialty available.

FEP Blue Focus

Tier 1
Preferred Generic Drugs

Typically the most affordable drug type, and are equal to their brand name counterparts in quality, performance characteristics and intended use.

Tier 2
Preferred Brand Name Drugs, Preferred Generic Specialty Drugs & Preferred Brand Name Specialty Drugs

Preferred brand name: Proven to be safe, effective, and favorably priced compared to Non-preferred brands.

Specialty: Used to treat complex health conditions. Proven to be safe, effective, and favorably priced compared to Non-preferred specialty drugs.

Try our Prescription Drug Cost Tool

Our Prescription Drug Cost Tool lets you check drug costs 24/7. See if your drug is covered under your selected plan and compare costs of covered drugs for all three plans.

Check Drug Costs

Prescription drug benefits for 2020

See 2021 benefit updates and rates here.

Standard Option Basic Option FEP Blue Focus
Preferred Retail Pharmacy Tier 1 (Generics): $7.50 copay for up to a 30-day supply; $22.50 copay for a 31 to 90-day supply

Tier 2 (Preferred brand): 30% of our allowance

Tier 3 (Non-preferred brand): 50% of our allowance

Tier 4 (Preferred specialty): 30% of our allowance

Tier 5 (Non-preferred specialty): 30% of our allowance



Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program.
Tier 1 (Generics): $10 copay up to a 30-day supply; $30 copay for a 31 to 90-day supply

Tier 2 (Preferred brand): $55 copay for up to a 30-day supply; $165 copay for a 31 to 90-day supply

Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum) for up to a 30-day supply; $210 minimum for a 31 to 90-day supply

Tier 4 (Preferred specialty): $65 copay for up to a 30-day supply; $200 copay for a 31 to 90-day supply

Tier 5 (Non-preferred specialty): $90 copay



Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program.

 Tier 1 (Generics): $5 copay for up to a 30-day supply; $15 copay for a 31 to 90-day supply

Tier 2 (Preferred brand): 40% of our allowance ($350 max) for up to a 30-day supply; $1,050 maximum for 31 to 90-day supply

Mail Service Pharmacy Tier 1 (Generics): $15 copay 

Tier 2 (Preferred brand): $90 copay 

Tier 3 (Non-preferred brand): $125 copay


Covers a 22 to 90-day supply. Nothing for the first 4 prescription fills or refills when you switch from certain brand name drugs to specific generic drugs.

Available to members with Medicare Part B primary only. Visit the Medicare page for more information. Not a benefit   
Specialty Pharmacy

Tier 4 (Preferred specialty): $50 copay for up to a 30-day supply; $140 copay for a 31 to 90-day supply 

Tier 5 (Non-preferred specialty): $70 copay for up to a 30-day supply; $200 copay for a 31 to 90-day supply


90-day supply may only be obtained after third fill.

Tier 4 (Preferred specialty): $70 copay 

Tier 5 (Non-preferred specialty): $95 copay


90-day supply may only be obtained after third fill.

Tier 2 (Preferred generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum)

Specialty drugs are limited to a 30-day supply.

This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s Federal brochures (Standard Option and Basic Option: RI 71-005; FEP Blue Focus: 71-017). All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures.

Some prescription drugs and supplies need prior approval

To give prior approval, we need to confirm two things: that you’re using the drug to treat something we cover and that your healthcare provider prescribes it in a medically appropriate way. Your healthcare provider can request prior approval electronically, by fax or by mail. The full list of drugs that need to be approved, prior approval forms and additional information can be downloaded here.

Covered equivalents for drugs not on our formulary

Standard Option and Basic Option have certain drugs that are not covered on their formularies. Each non-covered drug has safe and effective, alternative covered drug options. You can see the list of what’s not covered and available alternative options for Standard Option and Basic Option.

Get in Touch

Retail Pharmacy Program

Mail Service Pharmacy

For refills, call: 1-877-FEP-FILL (1-877-337-3455)

Specialty Drug Program

24/7 Nurse Line

Get prescription advice from a registered nurse