Prescription Drug Coverage

Benefits

Prescription drug coverage provided under both the Advantage PPO and Core High Deductible health plans has the following features:

  • Calendar-year deductible (must be met before copays apply except as noted for Core below)

Certain preventive medications for chronic conditions such as diabetes, high blood pressure, high cholesterol, asthma and heart conditions are covered with no deductible under the Core Plan. The copays based on the drug tier will apply. See the HSA Preventive Drug List for a list of these medications.

  • Calendar-year out-of-pocket maximum (includes copays and deductible)
  • Generic equivalents are required when available (see below)
  • Source Rx 1.0 Formulary applies (see below)
  • Network pharmacies

Mail-order pharmacy program through AllianceRx Walgreens Prime or at Walgreens retail stores:

  • Up to a 90-day supply
  • Tier 1 (usually generic drugs): $30 copay per prescription — a savings of up to $15
  • Tier 2 (usually preferred drugs): $60 copay per prescription — a savings of up to $30
  • Tier 3 (usually non-preferred drugs): 10% (minimum $120; maximum $300) copay per prescription — a savings of up to $150

90DayMyWay
Opportunity to purchase 90-day supply maintenance medications at Walgreens retail pharmacies for the same price as home delivery (two copays vs. three). Discount not available at other retail pharmacies.

Medication Synchronization
Optional opportunity to align maintenance medication refills to the same day, resulting in fewer trips to the pharmacy. Members’ copays can be prorated for the shorter supply to achieve same-day refills.

SourceRx 1.0 Formulary
Prescription drugs on both the Core and Advantage plans will be subject to the Prime Therapeutics SourceRx1.0 Drug List. A formulary is a list of covered and non-covered prescriptions. SourceRx 1.0 was designed to push back against today’s high-cost medications. It works by requiring alternatives to more expensive drugs. This helps you get the right medicine at the best cost. Note: The new formulary list will be available by approximately December 21, 2018.

SourceRx 1.0 Formulary Guide maintains an effective covered drug list by:

  • Managing non-preferred drugs, high cost brands and expensive generics
  • Excluding non-essential drugs such as non-FDA approved drugs and drugs with safety or efficacy concerns
  • Capitalizing on over-the-counter alternatives

Review the SourceRx 1.0 Formulary Guide. Always consult your doctor about treatment or prescription changes. This list may help guide you and your doctor in selecting an appropriate medication for you. If any of your medications are listed as non-covered, ask your doctor to prescribe a covered formulary medication.

Non-preferred Pharmacy
CVS charges more than other pharmacies for their services and products. Therefore, CVS (including those in Target stores) is considered a Non-preferred Pharmacy on the Regions Medical Plans. Copays will be higher when using CVS.

  • Tier 1 = +$5 or $20 copay per prescription
  • Tier 2 = +$10 or $40 copay per prescription
  • Tier 3 = +$10 or $70 minimum; $160 maximum copay per prescription

Required Generic Equivalents
Generic equivalent medications are required in both the Advantage and Core plans. A generic equivalent drug is a medication that has the same active ingredients as the brand name drug. If you purchase a brand name drug that has a generic equivalent, you will pay the full cost of the brand name drug. Be sure to tell your physician, during your office visit, that your plan requires generic equivalents. If he/she indicates DAW (dispense as written) on the prescription, the pharmacy will not be able to provide you with a generic equivalent, and you will pay the full cost of the drug.

To make the most of your prescription benefits, you may access the Rx Benefit Manager tool on the BCBS/PrimeMail website:

  • Go to bcbsal.com. Register or sign in (dependents must register separately) and follow this path: Pharmacy > Manage Rx Benefits > Rx Benefit Manager > Accept. Then enter the name of each  your prescriptions.
  • The results will show the current price of the drug and will give a list of generic equivalents, if applicable. It will also give a list of alternative medicines that might save you thousands of dollars
  • There’s also a claims history feature available for your use

What to know about the Prime Therapeutics Vaccine Network — available for influenza, pneumococcal and shingles vaccines:

  • All major pharmacy retailers and most independent pharmacies are in the Vaccine Network
  • Simply show your BCBS medical ID card and a photo ID to receive your vaccination
  • Flu shots are available to associates and dependents (generally age 7 and older)
  • Pneumococcal vaccines are recommended for age 65 and up or for those with certain health conditions
  • The shingles vaccine is recommended for those age 50 and up
  • Consult your physician or pharmacist with questions

To see if your pharmacy is in the Vaccine Network, go to alabamablue.com/primeparticipatingvaccinepharmacylocator. Enter your ZIP code and pharmacy name (optional), view network/plans, and look for the Vaccine Network.

Other Prescription Requirements
There are various clinical programs and reviews in place that help improve patient safety and health while also focusing on appropriate drug utilization and usage. Blue Cross Blue Shield/Prime Therapeutics aims to maintain the quality of your prescription drug benefits while keeping your prescription costs as low as possible.

Prior Authorization
Certain medications require prior authorization from the plan — with input from your physician — to be filled. This is a safety measure based on medical criteria or guidelines approved by the Food and Drug Administration (FDA) or the drug manufacturer.

Step Therapy
Certain medications require the use of first-line drugs — simple, inexpensive treatments that are known to be safe and effective for most people — prior to moving on to higher cost brand name drugs. To obtain a second-line drug, your physician must go through the prior authorization process.

Quantity Limits
Certain medications have quantity level limits in accordance with medical criteria or guidelines approved by the FDA or the drug manufacturer.

Think Benefits

Every time you get a new prescription:

  • Ask your doctor for a generic, if available
  • Ask your doctor for a 90-day prescription for maintenance medications; using mail order will save you money

Need Help?

Contact the HR Connect Team at 1-877-562-8383.