The pharmacy program is an integral part of our medical plan offerings. Our pharmacy program provides you with informational tools available through our administrator, Prime Therapeutics, to research the most cost-effective medication available for your condition, and gives you the option of a lower co-payment for using a generic medication if available.
OneBeacon® provides one pharmacy option, the FlexRx option, regardless of which medical plan you are enrolled in. The pharmacy program provides different levels of coverage based on the "tier" of medication that you are receiving.
There are three tiers of coverage:
- Generics (Tier1)
- Work the same as brand-name drugs and save you money.
- Features the lowest cost. If a generic version of your prescription is available it could save you up to 80%.
- Preferred Brand (Tier 2)
- List of prescription drugs considered to the "best choices" based on their safety, effectiveness, and cost that are not generics.
- These drugs offer the second lowest cost.
- Non-Preferred Brand (Tier 3)
- Brand-name drugs for which alternative are available in Tier 1 or Tier 2; or
- Not typically used as a first line of treatment; or
- Preferred specialty brand-name drugs
- These have a higher cost than Generics or Preferred Brand drugs
The formulary listing is developed by Prime Therapeutics, and may be found on the Blue Cross Blue Shield website. If you are on a maintenance medication (one which you take regularly), you must have your physician prescribe a 90-day supply, and may get it filled at a retail pharmacy or through Home Delivery. (Note: You will be allowed two 30-day fills before being required to have your physician write for a 90-day supply).
|Type of Prescription drug||30-day supply||90-day supply|
|Generic Drug||30% (up to $50.00)||30% (up to $125.00)|
|Preferred drug||30% (up to $150.00)||30% (up to $375.00)|
|Non-Preferred drug||30% (up to $250.00)||30% (up to $625.00)|
Specialty drugs are used to treat complex or rare conditions, are often injectables, oral, or inhaled prescriptions, and can cost hundreds or even thousands of dollars. The Blue Cross specialty drug program gives you a convenient and cost-effective way to order specialty drugs for delivery to your home.
|Specialty prescription drugs||Specialty pharmacy co-payment (30-day maximum supply)|
|Generic Drug||30% (up to $125.00)|
|Preferred drug||30% (up to $375.00)|
|Non-Preferred drug||30% (up to $625.00)|
Step Therapy Program
The Step Therapy Program, is designed for people who are diagnosed with certain conditions, such as arthritis or high blood pressure, which require them to take medications regularly. Step Therapy is a program designed to work with your physician to try a more clinically appropriate or cost-effective drug before Blue Cross Blue Shield will cover the alternative, higher-cost medication that was prescribed.
One additional note regarding the OneBeacon pharmacy program:
Medications that have over-the counter (OTC) equivalents such as ibuprofen and hydrocortisone creams, as well as non-sedating antihistamines, are not covered by the OneBeacon pharmacy plan.