Using your pharmacy benefits

Your 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 participating 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.

How are medications added to the formulary (covered drug list)

The services of an independent National Pharmacy and Therapeutics Committee (P&T Committee) are utilized to approve safe and clinically effective drug therapies. The P&T Committee is an external advisory body of experts from across the United States. The P&T Committee's voting members include physicians, pharmacists, a pharmacoeconomist and a medical ethicist, all of whom have a broad background of clinical and academic expertise regarding prescription drugs.

Common prescription benefit structures

The Metallic Drug List corresponds to our Gold, and Silver products that are qualified health plans (QHP). The specific dollar amount of copayment for each medication will vary depending upon your policy benefits.

Preventive prescription drugs are covered in full at no member cost.

Generic drugs will cost less and have lower copayments. Selecting generic drugs is a way to save money on your overall healthcare expenses.

Preferred brand drugs will cost less and may have lower copayments than non-preferred brand drugs.

Specialty drugs typically require defined handling and home storage demands, crucial patient education and careful monitoring. Some specialty drugs can be obtained only from specialty pharmacies. Preferred specialty drugs may cost less. There may be a difference in your copayment or coinsurance with non-preferred specialty drugs.

The Standard with Step Therapy Formulary promotes cost savings through using more generic medications rather than branded prescription drugs. The specific dollar amount of copayment for each medication will vary depending upon your policy benefits.

Preventive prescription drugs are covered in full at no member cost.

Generic drugs will cost less and have lower copayments. Selecting generic drugs is a way to save money on your overall healthcare expenses.

Coinsurance

Coinsurance only requires the member to pay a percentage of the discounted cost of the drug.

Coinsurance with a copay requires the member to pay a copayment for the drug and an additional percentage of the discounted cost of the drug.

High Deductible Health Plan/Health Savings Account (HDHP/HSA)

Members with a High Deductible Health Plan/ (HDHP) or a Health Savings Account (HSA) will get the benefit of the plan's discounted drug prices when using their prescription drug card. Those member's costs will be credited to the member's annual deductible and out of pocket limits.

Mail order [pdf]

Some plans offer mail order service through CVS Caremark Mail Order.

For more information

If you need more information about your prescription drug coverage, call 800-863-5561.