Pharmacy Benefits with Blue Cross :

If you have selected pharmacy benefits coverage from Blue Cross, or if pharmacy benefits are included in your existing health plan with Blue Cross, there are specific terms and information that you will need to be aware of. There are many situations that may affect the level of your coverage, as well as ways to make sure that you are getting the most out of your pharmacy benefit.

Participating Pharmacies - It is very important to have your prescription filled with a participating pharmacy under this plan. There are several ways to determine if your local pharmacy is a participating member of the Blue Cross pharmacy benefit program, including going online to the Blue Cross website. When you have your prescription filled at one of these participating pharmacies, you will only need to pay the co-pay for your prescription, as long as it is listed in the Blue Cross Formulary.

If you do not visit a participating pharmacy, there may be certain deductibles that you will need to pay, and you may need to pay 50% of the Limited Drug Fee Schedule in California. With certain prescriptions, this may mean that you would have to pay a great deal more than your usual co-pay. If you cannot find a participating pharmacy in your area, Blue Cross offers Precision Rx, a mail and Internet order alternative. This will allow you to enjoy your co-pay, and get your prescriptions delivered right to your door.

Formulary - Blue Cross uses a list of prescription drugs, called the Formulary, to determine what prescriptions are covered under your current benefit plan. This list should include the majority of currently used prescriptions, as well as their generic alternatives. If a prescription is not on the formulary list, this could mean that you will need to pay more money for this prescription.

If you are uncertain about a prescription being in the formulary, it is a good idea to inform your doctor that you would prefer a prescription that is eligible for your benefits. Provided that there are no contraindications or allergy problems associated with that medicine, your doctor should be able to find an alternative that is listed in the formulary. This may not always be the case, however, and it is important that you get the exact prescription you need, even if it isn’t covered in the formulary.

Generic and Brand Name Prescriptions - Your co-pay for generic prescriptions will be less than your co-pay for a brand name prescription under these plans. In addition, you may need to meet a brand name deductible if you prefer to take brand name medication. In most cases, this deductible is $250, which means that you will need to pay for 100% of your prescriptions until you reach this deductible. After this point, you are eligible for the brand name co-pay that is listed on your policy.

Generic alternatives are safe, and their costs are greatly reduced from their brand name counterparts. If you have any questions about a generic prescription, please ask your doctor to provide you with more information.

Prior Authorization of Benefits - There is a small list of medications that will require a prior authorization of benefits before you will be able to purchase them using your co-pay. This list is comprised of medications that have been shown to have caused adverse reactions or cases of misuse in the past. If your doctor prescribes a medication for you that is on this list, they will need to begin the process of obtaining authorization by faxing a form to WellPoint Pharmacy Management. Your pharmacist may also be able to complete this step. In the event of an emergency, you may receive a 72-hour supply of your medication while it is authorized.

What You’ll Need - When you go to pick up your prescription, you will need to have your Blue Cross I.D. card, as well as the prescription that was given to you by your doctor. You should also have your co-pay ready if the medication is eligible for your co-pay. If your doctor prescribed a name brand medication, you may ask the pharmacy to give you a generic alternative, so that you can save more money on your medication.

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