Understand Your Pharmacy Benefits

Based on your health care plan, your prescription drug costs depend on if you’ve met your in-network deductible.  

First, you’ll pay your prescription’s full cost upfront until you meet your in-network deductible.  After you’ve met your in-network deductible, you’ll pay a copay or coinsurance for covered prescription drugs.  Your out-of-pocket costs are based on the drug’s payment level tier and your plan benefits.  See how to review prescription drug lists and costs online.

To help lower your costs:

  • Fill your prescriptions at an in-network pharmacy
  • Ask your doctor if a covered alternative is an option
  • Get up to a 90-day supply of covered drugs used regularly1

Remember, pharmacy selections and your care are always between you and your doctor.  Ask your doctor if you have questions or concerns about your medications.

How Prescription Tiers Work 

Your health plan’s prescription drug list has many levels of coverage, called payment level tiers.  

Your pharmacy benefit has up to 6 payment level 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 tier level on your drug list. 

Using Your Drug List

After you meet your annual in-network deductible, you’ll pay for your prescription based on its payment level tier on the drug list.  

When you look up your prescription drugs, seeing the drug tier lets you know if you’ll pay lower or higher out-of-pocket costs.  It can also show you if it has any special requirements.

Prescription Drug Lists and Costs

Find your medication and learn more about viewing drug costs online:

 

Individual and Family Health Plans

Starting January 1, 2020

  • View Transcript

    At Blue Cross and Blue Shield of Montana (BCBSMT), we know pharmacy benefits and costs can be confusing.  We’re here to help make it a little bit easier for you to understand your drug coverage and cost. Let’s look at an example.

    Meet Sofia. She was diagnosed with asthma and her doctor prescribed a medication to treat it.

    With her BCBSMT health care plan, she wants to know if her medication is covered and what her total prescription cost may be.

    Luckily for Sofia, she can find these answers through her online member account. Under the “Quick Links”, Sofia selects the Prescription Drugs link to access MyPrime.com, the member website of BCBSMT’s pharmacy benefit manager.

    Once on MyPrime.com, Sofia can select “Find medicines” to search for her prescription drug. From there, she can see if her drug is covered and how much it may cost.

    For additional savings, Sofia can choose to “see all pricing options” to view generic options and in-network and value pharmacy costs. If her drug is not covered, Sofia can speak with her doctor to discuss her options.

    Keep in mind, drug costs are unique to every plan and prescription. They can also vary depending on your plan’s in network deductible, and benefits*. To find out how you can save on your covered drugs, visit MyBlueRxMT.com. 

     

Learn About Special Requirements

Some drugs listed in the drug list may have special requirements.  This means there may be extra steps to take before getting your prescription filled.

Prior Authorization

In some cases, your doctor will need to send us a pre-approval request before your prescription drug may be covered.

Step Therapy

You may need to first try a more cost-effective drug before some other drug may be covered.

Dispensing Limits

You may only be able to get a certain amount of your drug at one time.  Review drug dispensing limits.

Specialty Pharmacy Program

If you need a specialty medication, you may need to get it at an in-network specialty pharmacy.  View specialty pharmacy program details.

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1 Not all prescriptions can be filled in a 90-day supply and may need to be filled at select retail pharmacies or via home delivery. Based on your plan benefits, you may not save on your out-of-pocket costs but will spend less time going to the pharmacy.