Prescription Drug
We offer prescription drug coverage through Blue Cross Blue Shield. Prescription benefits are managed by Prime Therapeutics (MyPrime.) What you pay depends on the drug’s category, where you fill it, and which medical plan you chose.
Understanding Your Coverage
Preventive drugs. Many preventive drugs, and those used to treat chronic conditions like diabetes, high blood pressure, high cholesterol and asthma, are on the Preventive Condition Drug List. These are covered at 100%, at no cost to you when you use an in-network pharmacy.
Mail order pharmacy. If you take a maintenance medication on an ongoing basis, you can use the mail order pharmacy to save on a 90-day supply.
Pharmacy Categories
Medications are placed in categories based on cost, safety and effectiveness. Those categories affect what you pay.
Generic — A drug that offers equivalent uses, doses, strength, quality and performance as a brand-name drug, but isn’t trademarked.
Brand preferred — A drug with a patent and trademark name, considered preferred because it’s safe, effective and usually less expensive than other brand-name options.
Brand non-preferred — A drug with a patent and trademark name that isn’t preferred, and is usually more expensive than alternative generic and brand preferred drugs.
Specialty — A drug that requires special handling, administration or monitoring. Most can only be filled by a specialty pharmacy and need additional approvals.
What You Pay
| PHARMACY PROVISIONS | BCBSIL HDHP PLAN | BCBSIL PPO PLAN | ||
|---|---|---|---|---|
| In-network | Out-of-network | In-network | Out-of-network | |
| Prescription drug deductible | Combined with medical deductible | Combined with medical deductible | ||
| Retail pharmacy — up to a 30-day supply | ||||
| Generic | 20% after deductible1 (min $0 / max $15) | 20%* | 20%, no deductible1 (min $0 / max $15) | 20%, no deductible |
| Brand preferred | 20% after deductible1 (min $20 / max $60) | 20%* | 20%, no deductible1 (min $20 / max $60) | 20%, no deductible |
| Brand non-preferred | 20% after deductible1 (min $35 / max $100) | 20%* | 20%, no deductible1 (min $35 / max $100) | 20%, no deductible |
| Specialty | 20% after deductible1 (min $75 / max $500) | Not covered | 20%, no deductible1 (min $75 / max $500) | Not covered |
| Mail order pharmacy — 90-day supply | ||||
| Generic | 20% after deductible (min $0 / max $30) | Not covered | 20% (min $0 / max $30) | Not covered |
| Brand preferred | 20% after deductible (min $40 / max $120) | Not covered | 20% (min $40 / max $120) | Not covered |
| Brand non-preferred | 20% after deductible (min $70 / max $200) | Not covered | 20% (min $70 / max $200) | Not covered |
| Specialty | Not covered | Not covered | Not covered | Not covered |
* After deductible.
1 If a generic is available and you receive the brand name, you pay 20% of the brand name cost plus the difference in price.
Help with high-cost prescriptions
FlexAccess™ helps lower the cost of certain high-cost medications, at no additional cost. Call 888-302-3618 or email FlexAccess Services.
If you’re in the high-deductible plan and haven’t met your deductible, you can sign up for a drug manufacturer’s coupon or copay assistance program. Call Prime Member Services at 844-210-0823.
Contact
Prescription Drug coverage for BCBSIL Members
800-423-1973