Prescription Drug Benefits

Which Prescription Drugs Are Covered

Check your Benefit Certificate to see if your prescription drugs are covered. The drug list consists of most preferred generic and many brand-name medications. Choosing drugs from this list may save you money.

If you don't see your medication on the list check with your doctor for a generic or lower-cost option on the drug list that may work just as well and may save you money!

Note that some drug classes may be excluded by some plans and therefore may not be covered under your pharmacy benefit. Your plan may have a different coverage level for specialty drugs. If you have questions about your coverage for specialty medications or your prescription drug benefit, call 1-800-521-2227 to talk to a Customer Advocate.

Where to Fill Your Prescriptions

To use your prescription drug benefits:

• Find a contracting pharmacy near you and show them your member ID card.
• For maintenance medications, you can have a 90-day supply sent right to your home. Your plan may also allow you to fill a 90-day supply of your maintenance medication(s) at a contracting pharmacy. Be sure to check your plan documents to verify.
• Log in to Blue Access for Members^SM to find the prescription drug forms that specifically apply to your coverage under the "Forms and Documents" tab.

Medications That Must Be Preapproved

Under the Prior Authorization Program, your doctor has to get approval from Blue Cross and Blue Shield (BCBS) before your prescription drug plan will cover certain medications and drug categories.

Visit MyPrime to see if any special requirements apply for your drug(s).*

Medications That Require a Prescription History

The Step Therapy Program encourages safe, cost-effective medication use by requiring you to have a prescription history for a "first-line" medication before your benefit plan will cover a "second-line" drug.

• A first-line drug is recognized as safe and effective in treating a specific medical condition, as well as being a cost-effective treatment option.
• A second-line drug is a less-preferred or potentially more costly treatment option.

Visit MyPrime to see if any special requirements apply for your drug(s).*

If you are taking or prescribed a drug that is part of the Step Therapy program, your doctor will need to write you a prescription for a first-line drug or submit a prior authorization request form for that prescription to BCBS. Your doctor can find the forms on the provider portal.

If you are a current member and have recently gone through the Step Therapy Program for a particular drug, you do not have to complete it again for that drug.

Estimate Prescription Drug Prices

You can estimate how much your prescription medications will cost at MyPrime.

Visit MyPrime to find prices for your medications and learn how to keep costs down.

Other Prescription Drug Information

Certain medications have special rules for coverage which may include:

• Higher out-of-pocket costs for name-brand drugs that have generic or over-the-counter versions
• Specialty medications used to treat complex medical conditions
• Restrictions on how much of a drug is covered at once and how often you can get coverage for that prescription refilled at that quantity

*You may have a custom Prior Authorization or Step Therapy drug list. Please check your benefits documents for the most accurate information.

Specialty Pharmacy

Specialty medications include those used in the treatment of complex medical conditions. Examples include hepatitis C, hemophilia, multiple sclerosis and rheumatoid arthritis.

Through the Prime Specialty Pharmacy, you can have self-administered specialty drugs delivered directly to you or your doctor's office.

View the Specialty Pharmacy Program Drug List which includes a reminder about coverage for self-administered specialty medications.