Drug pricing

Pharmacy benefits are administered through the Octave Blue Cross and Blue Shield Pharmacy Program, which eliminates paper claim forms and employs the latest technology for electronic pharmacy claims processing. When you fill your prescription at a participation pharmacy, the Pharmacy Program computer network instantly alerts the pharmacist to the following:

• Any potential harmful interaction of the medication about to be dispensed with any other medication that the patient may already be taking;
• Whether this medication may duplicate another medication the patient is taking;
• Whether the prescribed dosage or strength is appropriate for the age of the patient.

These features help you save money and promote good health and safety.

Options

Select the benefit option to view prescription drug pricing:

Standard with Step Therapy Formulary

• $500 deductible with 20% coinsurance after deductible is met
• $10/$30/$50 copay
• 0% Coinsurance after $5000 Deductible

Metallic Drug List - 2025

• Gold Standardized : $0/$15*/$30*/$60*/$250*/$250*
• Silver AH : $0/$100*/$1000*/$2000*/$5950*/$5950*
• Silver Standardized : $0/$20*/$40*/$80/$350/$350
• Silver Classic Suitcase : $0/$35*/$240*/$1600*/$5000*/$5000*
• Bronze Exp Standardized: $0/$25*/$50/$100/$500/$500
• Bronze Value: $0/$30*/$160*/$1600*/$5000*/$5000*

Metallic Drug List - 2024

• Gold Standardized : $0/$15*/$30*/$60*/$250*/$250*
• Silver AH : $0/$100*/$1000*/$2000*/$6150*/$6150*
• Silver Standardized : $0/$20*/$40*/$80/$350/$350
• Bronze Exp Standardized: $0/$25*/$50/$100/$500/$500
• Bronze Value: $0/$30*/$160*/$1600*/$5000*/$5000*

*tier is not subject to Deductible