Look Up Prescription Drugs
Starting January 1, 2023, some prescription drugs:
- May move to a higher or lower drug tier
- May be added to or removed from the drug list
- May have new special requirements
2023 Drug List
Here’s your 2023 drug list (for coverage that renews or starts on or after January 1, 2023):
$0 HDHP-HSA Preventive Drug List (This applies only for Blue Preferred Bronze PPOSM 502 plan)
Please note that some drugs may be covered under your health plan’s medical benefits instead of your pharmacy benefits.2
- Medical benefits: drugs covered under your medical benefits must be given to you by a health care professional in a hospital, office or health care setting.
- Pharmacy benefits: drugs covered under your pharmacy benefits are prescribed medicines you can take on your own.
If you are taking or prescribed a drug that is not on your plan’s drug list, call the number on your member ID card to see if the drug may be covered by your plan’s medical benefits.
Drugs with Additional Requirements
When reviewing your drug list, you might find letters in the additional requirements column. Here's what they mean:
- PA (prior authorization) – A medicine may need to be pre-approved before it can be covered by your plan.
- ST (step therapy) – You may need to try a more cost-effective drug first before other drugs may be covered.
- QL (dispensing or quantity limits) – You may only be able to get a certain amount of your drug at one time.
Talk with your doctor if your drug has an additional requirement.
Your health plan’s prescription drug list has many levels of coverage, called member payment tiers.
Some plans have up to 4 tiers and some plans have up to 6 tiers. Each tier has its own cost. Most often, the lower the tier, the lower your out-of-pocket costs will be for the drug.
When you get a prescription, you can look up the drug tier on your drug list.
Ways to Save
- You can save money by using an in-network pharmacy. Your out-of-pocket costs are often lower at an in-network pharmacy.
- At a value pharmacy, you may pay the lowest copay or coinsurance.3 You may also fill up to a 90-day supply of most covered drugs in store or through home delivery.
To find all pharmacies in your 2023 network, visit myprime.com.
Please note, changes could be made to the pharmacies in the future.
Drug Coupons
If you use a drug manufacturer’s coupon or copay card to pay for a covered prescription drug, this amount will not apply to your plan deductible or out-of-pocket maximum (unless it is a permitted third-party cost sharing payment).
Things to Do
Talk with your doctor about your next steps. Your doctor or pharmacist can answer questions or concerns you may have about your prescribed medications. Pharmacy selections and your care are always between you and your doctor.
- Lower Cost Alternatives Ask about lower-cost alternatives if your drug moves to a higher tier.
- Drug Options Review other options if your drug is no longer covered (often a covered generic or brand alternative may be available).
- Prescription Updates Have an authorization request sent to us, or change your prescription, if your drug has an additional requirement.
- Stay In-Network Order your prescriptions to be filled at in-network pharmacies.
More Suggestions For You
1 Coverage is based on the terms and limits of your plan. For some drugs, you must meet certain criteria before prescription drug coverage may be approved.
2 Drugs that have not received U.S. Food and Drug Administration (FDA) approval are not covered. Some benefit plans may have preventive drug benefits. This means you may pay a lower cost, as low as $0, for preventive care drugs. If your plan has preventive drug benefits, and coverage for your prescription changes, the amount you pay under the preventive drug benefit may also change. Some drugs may be covered under your medical plan instead of your pharmacy benefits.
3 The value pharmacy network pricing isn't available for 100% cost-sharing plans.