Medical / Prescription Drugs

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Medical / Prescription Drugs

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

Use your Blue Cross Blue Shield Illinois medical card for prescription claims – it is used for both prescription and medical.

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. BCBSIL Group Pharmacy Mail Order Member Flier
  • 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.  BCBSIL Group and IFM Prime Specialty Pharmacy Medications Member Flier

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.