Medical / Prescription Drugs

Prescription drug coverage through Prime Therapeutics is included when you enroll in the BCBSIL PPO or HDHP (HSA-Eligible) Plan.

Filling your Prescriptions

• You may fill 30-day prescriptions at participating retail pharmacies that are in the Traditional Select network.  Learn more about the plan network at www.myprime.com.
• You can get 90-day prescriptions at any extended supply retail network pharmacy. To find a location near you, visit www.myprime.com.
• You also have the option to have your prescriptions mailed directly to your home using Express Scripts Pharmacy.  To start using the pharmacy service, create an account at www.express-scripts.com/rx or call 1-833-715-0942. Your doctor can send new prescriptions electronically to EXPRESS SCRIPTS HOME DELIVERY.
• Certain Specialty Medications must be filled through Accredo or another in-network specialty pharmacy to avoid paying higher out-of-pocket costs. To start using Accredo, visit www.accredo.com or call 1-833-721-1619.

Medication Levels and Cost

Cost for medications vary based on the level of the drug selected by the healthcare provider. The three levels are:

Generic

The therapeutic equivalent to its brand-name counterpart because it contains identical active ingredients at the same doses.

1. If you are prescribed a brand-name drug, you pay the cost difference between the brand-name and generic drug.
2. If you receive a prescription for a brand-name drug where there is no generic available, you will continue to pay the applicable brand copay/deductible.

Preferred Brand

Prescription drug that has been recommended and is continually reviewed by Prime Therapeutics for both quality and cost-effective performance. By selecting a brand-preferred drug, you and your physician maximize your health benefits while minimizing overall prescription drug costs to you and Smiths. See which drugs are brand preferred at www.MyPrime.com.

Non-Preferred Brand

When your doctor prescribes a brand-name drug that is not on the preferred drug list, you will pay the highest coinsurance.

What’s the main difference between the two medical plans’ prescription drug coverage?

• The PPO prescription coverage is NOT subject to the deductible ($1,000/$2000).  You begin paying the coinsurance/copay right away.
• The HDHP coverage kicks in only one you have met the deductible ($1750 /$3500). You begin by paying the plan cost of the prescription until you meet your annual deductible.  After that, you will only be charged the applicable coinsurance/copay.