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.
Drug tiers
We organize our covered prescription drugs into tiers. The amount you pay for a drug depends on the tier. In general, the lower the drug tier the more cost effective the drug. Basic Option and Standard Option each have five drug tiers. FEP Blue Focus has only two drug tiers.
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.
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.
Prescription drug benefits for 2023
| FEP Blue Focus | Basic Option | Standard Option | |
|---|---|---|---|
| Preferred Retail Pharmacy |
Tier 1 (Generics): $5 copay; $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 |
Tier 1 (Generics): $15 copay up to a 30-day supply; $40 copay for a 31 to 90-day supply Tier 2 (Preferred brand): $60 copay for up to a 30-day supply; $180 copay for a 31 to 90-day supply Tier 3 (Non-preferred brand): 60% of our allowance ($90 minimum) for up to a 30-day supply; $250 minimum for a 31 to 90-day supply Tier 4 (Preferred specialty): $85 copay Tier 5 (Non-preferred specialty): $110 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): $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.
|
| Mail Service Pharmacy |
Not a benefit |
Available to members with Medicare Part B primary only. Visit the Medicare page for more information. |
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. |
| Specialty Pharmacy |
Tier 2 (Preferred generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum) Specialty drugs are limited to a 30-day supply. |
Tier 4 (Preferred specialty): $85 copay for up to a 30-day supply; $235 copay for a 31 to 90-day supply Tier 5 (Non-preferred specialty): $110 copay for up to a 30-day supply; $300 copay for a 31 to 90-day supply
90-day supply may only be obtained after third fill. |
Tier 4 (Preferred specialty): $65 copay for up to a 30-day supply; $185 copay for a 31 to 90-day supply Tier 5 (Non-preferred specialty): $85 copay for up to a 30-day supply; $240 copay for a 31 to 90-day supply
90-day supply may only be obtained after third fill.
|
Some prescription drugs and supplies need prior approval when using your pharmacy benefits
To give prior approval, we need to confirm two things: that you’re using the drug to treat something we cover and that your health care provider prescribes it in a medically appropriate way. Your health care 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
In 2023 we will also require prior approval for select high-cost drugs when using your medical benefits
Your health care provider can request prior approval by contacting your local BCBS company. The full list of these select high-cost drugs can be downloaded here
Covered equivalents for drugs not on our formulary
Our three plan options 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. FEP Blue Focus members can apply for coverage of a drug not covered on their formulary with the Non-Formulary Exception Process (NFE) form.
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