Understanding Your Pharmacy Benefits: Making the Most of Your Prescription Coverage
Prescription medications are an important part of staying healthy and understanding your pharmacy benefits can help you save money and avoid surprises at the pharmacy.
In-Network Pharmacies
When you are having a prescription filled, make sure you are filling it at an in-network pharmacy. This will ensure you are utilizing your plan pharmacy benefits and receiving the best cost.
Prescription Drug Coverage
One of the first things to know is that every health plan has a formulary, or medication list, that shows which prescription drugs are covered. Before filling a prescription, it's a good idea to check whether your medication is included on your plan's formulary and what your cost may be. BCBSKS members with pharmacy benefits can view prescription drug information through their BlueAccess account. Once you are logged in, scroll down to the prescription drugs section and select Find Drugs. From here you can find covered medications, search for generic alternatives, find in-network pharmacies and compare costs.
Generic Medications
You may also be able to lower your costs by choosing generic medications when available. Generic drugs contain the same active ingredients as their brand-name counterparts and often provide a more affordable option. Many members can save money simply by asking their doctor or pharmacist if a generic alternative is available.
90-Day Supply
If you take a medication regularly to manage a chronic condition, called a maintenance drug, ask your doctor or pharmacist whether a 90-day supply is an option. Depending on your plan and medication, receiving a 90-day fill may be more cost-effective and more convenient than monthly refills and can help ensure you don't miss doses because you've run out of medication. A 90-day supply may also reduce trips to the pharmacy and make it easier to stay on track with your treatment plan.
Mail-Order Pharmacy Services
For medications you take regularly, mail-order pharmacy services can offer added convenience and potential cost savings. Instead of making trips to the pharmacy, eligible prescriptions can be delivered directly to your home, helping you stay on track with your treatment plan.
Prior Authorizations
Some medications may require prior authorization before they are covered. This means your doctor may need to provide additional information to show the medication is medically necessary. While this is an extra step, it helps keep medication costs down, while ensuring medications are used safely, appropriately and according to your plan's coverage guidelines.
Specialty Medications
Members who use specialty medications for complex or chronic conditions may have additional pharmacy resources available. Specialty medications often require special handling, storage, monitoring or support from trained health care professionals. Depending on your plan, specialty prescriptions may be required to be filled through certain designated specialty pharmacies that provide education, care coordination and home delivery services.
Taking a few minutes to understand your pharmacy benefits can help you make informed decisions about your medications and health care costs. If you have questions about coverage, participating pharmacies, mail-order options or prescription costs, BCBSKS representatives can help you better understand your benefits and available resources.