When you enroll in the Consumer Choice Plan for medical coverage, you automatically receive prescription drug coverage through Express Scripts.
You pay the full cost for prescription drugs until you meet the medical plan deductible. Then you pay the applicable copay. The plan pays 100% once you meet the medical plan out-of-pocket maximum. Prescription drugs are not subject to a separate out-of-pocket maximum. Certain preventive drugs are covered 100%, the deductible does not apply.
Here’s a high-level overview of the prescription drug benefit. For details, review the Blue Cross Blue Shield Medical SPD.
|Features||Participating Pharmacy||Non-Participating Pharmacy|
|Annual Deductible||Medical plan deductible applies|
|Annual Out-of-Pocket Maximum||Eligible expenses apply toward the individual and family in-network medical out-of-pocket maximum|
|What you pay|
|Retail (up to 30-day supply)|
|Generic||$10 copay||Copays same as a participating pharmacy, but retail pricing applies|
|Formulary (preferred brand)||25% (min $20; max $50)|
|Nonformulary (non-preferred brand)||35% (min $40; max $70)|
|Generic||$20 copay||Copays same as a participating pharmacy, but retail pricing applies|
|Formulary (preferred brand)||25% (min $40; max $100)|
|Nonformulary (non-preferred brand)||35% (min $80; max $140)|
|Home Delivery (up to 90-day supply)*|
|Generic||$20 copay||Not covered|
|Formulary (preferred brand)||25% (min $40; max $100)||Not covered|
|Nonformulary (non-preferred brand)||35% (min $80; max $140)||Not covered|
- If you or your doctor request a brand-name drug when a generic is available, you will pay the generic copay plus the difference in cost between the brand and the generic.
- Manufacturer-funded patient assistance for widely distributed specialty medications will not be considered as true out-of-pocket expenses and may not apply to deductible and out-of-pocket maximums.
- Infertility medications have a pharmacy-only lifetime limit of $40,000.
Express Scripts appSkip the pharmacy trip and download the Express Scripts mobile app.
- View your past prescription activity and payment details.
- Switch to home delivery.
- Manage prescriptions and check for drug interactions.
- Refill and renew home delivery prescriptions.
- Check order status.
- Access your ID card at any time.
Express Scripts Support
Programs that offer financial support for prescription drugs:
- Extended Payment Program: Pay for home delivery prescriptions in three monthly installments instead of paying the full amount all at once. Log into Express Scripts, then click Account > Payment Methods > Edit Information.
- Patient Assurance Program: Limits cost of 30-day preferred insulin prescription to no more than $25.