Understanding prescription drug benefits
Knowing how your benefits work with different types of prescription drugs can help you manage costs.
What prescriptions do health plans cover?
Not all health plans cover the same prescription drugs. Your health plan has a list of all the drugs it covers, called a formulary. If you need a drug your plan doesn’t cover, you will have to pay more — possibly the full price — out of your own pocket.
You may also have to share the cost of some covered drugs with your plan. How much you pay depends on the type of drug and the tier the drug is in.
Where you get your prescriptions filled can also affect how much you pay for drugs. Use a pharmacy that's in your plan network to get the highest level of coverage.
View covered drugs
Log in to your member account to find medicines in your covered drug list and pharmacies in your network.
Drug types
Prescription drug types and tiers
Blue Cross and Blue Shield of Minnesota and Blue Plus health plans usually group covered drugs into numbered tiers, which vary by plan.
Generally, the lower the tier number, the less you will pay for your drugs.
Each tier includes different types of drugs.
Below are examples of tiers and types of drugs you might see in your plan materials:
Tier 1: Preferred generic drugs
Generic drugs have the same active ingredients and work the same way as the brand-name drugs they copy.
They usually cost less than the brand-name versions.
Tier 2: Non-preferred generic drugs
You will pay more for these generic drugs than for preferred generic drugs.
Tier 3: Preferred brand drugs
These drugs are included in a plan’s list of covered drugs and may not have a generic version.
They cost more than generic drugs but less than non-preferred brand drugs.
Tier 4: Non-preferred brand drugs
You will pay more for these drugs than for preferred brand drugs.
You may be able to get a generic drug instead that will cost you less.
Tier 5: Specialty drugs
These drugs are used to treat ongoing health conditions and can be costly.
They often require special handling and may have to be ordered through a specialty pharmacy.
How to save
How to save on prescription drugs
Prescription drugs can be costly even when they’re covered by your health plan.
Here’s how you can save money without putting your health at risk:
Start with generic
If your medication is available as a generic, try that first.
Check your plan's covered drug list
If your drugs aren’t listed, ask your doctor for a similar drug your plan will cover. Covered drug lists (Formularies) can change throughout the year.
Find a pharmacy in your plan network
You’ll pay more for prescriptions you have filled at pharmacies that are not preferred or in your network.
Check with your plan to find an in-network pharmacy near your home or work.
Log in to your member account for direct access to your covered drug and pharmacy directories.
Use a prescription delivery service
You may be able to save money using a mail order pharmacy for medications you take for chronic conditions like high blood pressure or diabetes. Your prescription drugs will be sent directly to you by mail.
Learn about the prescription delivery
Talk with your doctor
If you find it difficult to manage the cost of your prescription drugs, ask your doctor about alternative medications that may cost less.
Take medicine as directed
Taking your drugs only half the time or taking just half the dose to save money can put your health at risk and lead to bigger bills down the road.
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Drug programs
Prescription drug programs
Your health plan may have programs in place to help control costs and ensure the safe use of prescription drugs.
These programs may include:
Step therapy
With this program, your plan requires your doctor to first prescribe a safe, lower-cost drug before stepping up to a drug that may be newer or more costly.
Prior authorization
To ensure safe and appropriate use, some drugs must be approved by your health plan before they will be covered.
Quantity limits
This program promotes safe use and automatically limits how often you can get a drug filled or how much you can get at one time.
IntegratedRx
Your pharmacy benefit provides access to convenient pharmacy options, allowing your prescribed oral cancer drug(s) to be filled at local participating pharmacies that are part of clinics, hospitals and/or health systems.
This enables you to pick up your prescription in-clinic.
If one of these new participating pharmacies is more convenient for you, ask your prescriber about moving your prescription.
We're here to help
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Speak with a Blue Cross representative
1-800-262-0823 (TTY 711)