You also can order routine medications through the mail-order service. With this feature, you can receive up to a 90-day supply of drugs. This is an easy way to get the drugs you use on a routine basis, such as allergy or blood pressure medications.
For both retail and mail-order prescriptions, you pay different copayments for generic, preferred brand name, and non-preferred brand name. Ask your physician to write GENERIC or formulary-drug prescriptions to SAVE YOU MONEY.
|Prescription Drugs||Retail Copayment
|Preferred brand name||$40 copay|
|Non-Preferred brand name||$70 copay|
|Prescription Drugs||Mail Order Copayment
|Preferred brand name||$120 copay|
|Non-Preferred brand name||$210 copay|
If your prescription is for a long-term (maintenance medication), consider using the mail-order pharmacy to save money. Log onto www.bcbstx.com and click on “Prescription” for mail order information. It includes an order form for your first prescription order. Complete the form and send it along with the written prescription from your physician to the address on the order form.
The prescription drug benefit program now includes a mandatory Specialty Pharmacy provision for specialty prescriptions through Prime Therapeutics. Should you need to fill a specialty prescription, you will need to utilize a specialty pharmacy. If the specialty pharmacy is not used, you will be responsible to pay the full cost of the prescription. For 24/7 assistance with you specialty medication, call 1-877-627-6337.
Step Therapy through Blue Cross Blue Shield and Prime Therapeutics
The step therapy program encourages safe and cost-effective medication use. Under this program, a “step” approach is required to receive coverage for certain high-cost medications. This means that to receive coverage, you may need to first try a proven, cost-effective medication before using a more costly treatment, if needed. Remember, treatment decisions are always between you and your doctor.
The step therapy program requires that you have a prescription history for a “first-line” medication before your benefit plan will cover a “second-line” drug. If you are currently taking a medication that is covered under this program, it will be grandfathered and nothing is required of you.
- A first-line drug is recognized as safe and effective in treating a specific medical condition, as well as being cost-effective.
- A second-line drug is a less-preferred or sometimes more costly treatment option.
When possible, your doctor should prescribe a first-line medication appropriate for your condition.
If your doctor determines that a first line drug is not appropriate for you or is not effective for you, your prescription drug benefit will cover a second-line drug when certain conditions are met.
The prior authorization program encourages safe and cost-effective medication use. The program applies to certain high-cost drugs that have the potential for misuse. Before medications included in the prior authorization program can be covered under your benefit plan, your doctor will need to get approval through Blue Cross and Blue Shield of Texas.
If you are already taking or are prescribed a drug that is part of the prior authorization program, your doctor can submit a prior authorization request form so your prescription can be considered for coverage. Your doctor can find prior authorization forms on the provider website at www.bcbstx.com. Your doctor may also call 800-289-1525 with questions or to get a form.
If the prior authorization request is approved: You will pay the appropriate amount based on your prescription drug benefit when you fill your prescription.
If the prior authorization request is not approved: The medication will not be covered under your prescription drug benefit. You can still purchase the medication, but you will be responsible for the full cost. You can talk to your doctor to find out if another drug might be right for you. Remember, treatment decisions are always between you and your doctor. As always, the appeal rights provided by your benefit plan are available to you.
Under your pharmacy benefit plan administered by Blue Cross Blue Shield of Texas (BCBSTX), a Division of Health Care Service Corporation, compound drugs will not be covered under your prescription drug benefits for plan participants age 13 and over.
Compound drugs are two or more drugs that a licensed pharmacist combines, mixes, or alters the ingredients of a drug to create a drug tailored to the needs of a single patient. Compound drugs are not approved by the U.S Food and Drug Administration (FDA) and have not been tested for safety, effectiveness, or side effects by the FDA.
Get Discounts on your Rx
Do you or someone in your family have an RX drug that’s expensive or not covered by insurance? Use your freshbenies prescription discounts and save an average of 42% of most pharmacies nationwide including CVS and Walgreens. To learn more or get a price quote for your drug at local participating pharmacies: www.freshbenies.com/service/pharmacy or by phone at 855-647-6762.
Voluntary Rx through ScriptSourcing
ScriptSourcing provides a unique opportunity to help employees save money on name brand medications. Simply call 410-902-8811, and a Prescription Advocate will walk you through the enrollment process.
It’s never been easier for our plan members to enroll in our $0 rx copay program!
- Search for eligible meds: https://scriptsourcing.com/med finder/
- Identify medications eligible for our services
- Click the calendar tool to schedule a call with our advocacy team for enrollment
Some of the advantages of joining the ScriptSourcing program are:
- Employees and Dependents pay $0 Copay for name-brand maintenance medications
- Prescriptions are shipped directly to your home with no shipping or handling costs
- No out-of-pocket expenses
- ScriptSourcing saves the health plan money, which translates into lower premiums