Important Information Non-Discrimination Notice Company Information Site Map Careers Contact Us Employers Producers Providers Welcome Employers Producers Providers Company Information Feedback Language Assistance En español Ask IVY SM our virtual assistant Insurance Basics Shop Plans & Products Find a Doctor or Hospital Member Services Sign Up or Log In Know the Basics Choose a Plan Get Member Support Pay My Bill Contact Us Learn About Pharmacy Benefits When you get a prescription, here’s what you may want to know. Understand Your Pharmacy Benefits Based on your health plan, your prescription drug costs may depend on if you’ve met your in-network deductible. First, you’ll pay your prescription’s full cost upfront until you meet your in-network deductible. After you’ve met your in-network deductible, you’ll pay an out-of-pocket cost of a copay or coinsurance for covered prescription drugs. Your out-of-pocket costs are based on the drug’s payment tier and your plan benefits. See how this all works when you get a prescription: View Transcript Help With Lowering Your Costs You may keep your prescription drug costs down if you: Fill your prescriptions at an in-network pharmacy Ask your doctor if a covered alternative is an option Get up to a 90-day supply of covered drugs used regularly1 See how to review prescription drug lists and costs online. Remember, pharmacy selections and your care are always between you and your doctor. Ask your doctor if you have questions or concerns about your medications. How Prescription Drug Tiers Work Your health plan’s prescription drug list has many levels of coverage, called member payment tiers. Your pharmacy benefit has up to 6 tiers. Each tier has its own cost. Most often, the lower the tier, the lower your out-of-pocket costs will be for the drug. When you get a prescription, you can look up the drug tier on your drug list. Understanding and Using Your Drug List After you meet your annual in-network deductible, you’ll pay for your prescription based on its tier on the drug list. When you look up your prescription drugs, seeing the drug tier lets you know if you’ll pay lower or higher out-of-pocket costs. It can also show you if your prescription drugs have any additional requirements. The example from the drug list shows a drug that: Is in tier 5 (preferred specialty drug) Requires prior authorization Has a dispensing limit Prescription Drug Lists and Costs Find your medication and learn more about viewing drug costs online: 2021 Individual and Family Health Plans 2021 HMO Drug List 2021 Non-HMO Drug List 2022 Individual and Family Health Plans 2022 HMO Drug List 2022 Non-HMO Drug List 2022 $0 HDHP-HSA Preventive Drug List (This applies only for Blue Choice Preferred Bronze PPOSM 502 plan) View Transcript Review Your Pharmacy Benefits Visit Blue Access for MembersSM (BAMSM) to find in-network pharmacies and learn more. Log in To BAM Learn About Additional Requirements Some drugs listed in the drug list may have additional requirements. This means there may be extra steps to take before getting your prescription filled. Prior Authorization In some cases, your doctor will need to send us a pre-approval request before your prescription drug may be covered. Step Therapy You may need to first try a more cost-effective drug before some other drug may be covered. Dispensing Limits You may only be able to get a certain amount of your drug at one time. Review drug dispensing limits. Specialty Pharmacy Program You may need to get a specialty drug at an in-network specialty pharmacy. Some drugs may be filled in a smaller amount (split fill), letting you try them at a prorated cost first. View specialty pharmacy program details. More Suggestions For You Scheduling Your Annual Exam Go Understand Health Care Plans Go Useful Tools and Resources Go 1 Not all prescriptions can be filled in a 90-day supply and may need to be filled at select retail pharmacies or via home delivery. Based on your plan benefits, you may not save on your out-of-pocket costs but will spend less time going to the pharmacy. 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