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Prescription Drugs

When you enroll in a BMO medical plan, you automatically receive prescription drug coverage.

Prescription drug coverage is available through Express Scripts if your medical plan is administered by Blue Cross Blue Shield of IL (BCBSIL) and through Kaiser Pharmacy if Kaiser administers your medical plan. Here’s a high-level overview of prescription drug benefits.

BCBSIL: Express Scripts

In-Network Features	HDHP	PPO
Annual Deductible	Combined with medical	Individual: $250 Family: $500 (for prescription drugs only)
Annual Out-of-Pocket Maximum	Combined with medical
Good to Know	Express Scripts provides digital ID cards; physical cards are not provided. You can view, print, or download your digital ID card anytime on the Express Scripts website or the mobile app. Smart90, a feature of your prescription drug benefit, requires you to fill maintenance medications at a Smart90 retailer (Walgreens or CVS) or through Express Scripts home delivery. You can get two retail 30-day grace fills for maintenance medications. Prescription drugs are subject to the medical plan deductible (some exclusions apply). Lifetime limit for Infertility medications: $40,000.
	What You Pay (Retail Pharmacy: Up to 30 day supply; Home Delivery: Up to 90 day supply)
Generic	Retail Pharmacy: $10 copay Home Delivery: $25 copay
Preferred Brand	30% coinsurance Retail Pharmacy: $25 minimum; $100 maximum Home Delivery: $62.50 minimum; $250 maximum
Non-Preferred Brand	40% coinsurance Retail Pharmacy: $50 minimum; no maximum Home Delivery: $125 minimum; no maximum
Specialty Drugs (used to treat complex and chronic health conditions)	Based on category (generic, formulary, non-formulary). Must be filled through Express Script’s specialty home delivery pharmacy, Accredo, which provides 24/7 access to speciality-trained pharmacists and nurses who understand your condition.

Kaiser Pharmacy

In-Network Features	HDHP	PPO
Annual Deductible	Combined with medical	Individual: $250 Family: $500 (for prescription drugs only)
Annual Out-of-Pocket Maximum	Combined with medical
	What You Pay (Retail: Up to 30 day supply, Mail order: Up to 100 day supply)
Generic (Tier 1)	Retail: $10 copay Mail order: $20 copay
Preferred Brand (Tier 2) Non-Preferred Brand (Tier 3) Specialty Drugs	Review your regional Kaiser SBC: 2025 Kaiser HDHP California 2025 Kaiser HDHP Colorado 2025 Kaiser HDHP Northwest 2025 Kaiser DHMO California 2025 Kaiser DHMO Colorado 2025 Kaiser DHMO Northwest