2018 Prescription Drug Changes for Individual or Employer-Offered “Metallic” Plans
Drug List Changes
Drugs that move to a higher payment level tier may still be covered. However, you may have to pay more out-of-pocket based on your benefits. Talk with your doctor if you have any questions about your prescription.
Here are your 2018 drug tier changes:
Prescription Drug Payment Level Tiers
*Not all plans have 6 tiers.
Drugs No Longer Covered
Some drugs will no longer be covered in 2018. Make sure to talk with your doctor about your options for covered generic or brand alternative drugs. See below for the most often used drugs that will no longer be covered, a list of covered alternatives for these drugs and a full list of drugs that will no longer be covered.
Also, drugs that aren't U.S. Food and Drug Administration (FDA) approved are not covered.
Commonly Used Drugs No Longer Covered*
*May not apply to all strength/formulations. Third party brand names are the property of their respsective owners.
Newly Covered Drugs
2018 Drug List
Utilization Management Programs
Coupons for Individual Plan Members Only
Coverage for new drugs added to your plan will begin when your 2018 plan renews or starts.
Sample of Newly Covered Drugs*
*May not apply to all strengths/formulations. Third party brand names are the property of their respective owners.
View your 2018 drug list (for coverage that renews or starts on or after January 1, 2018):
* Applies for Blue Preferred Silver PPO 101 – Three $0 PCP Visits only
New drugs are being added to the utilization management programs when your coverage renews or starts in 2018. Select the program name to view its list:
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).
Using In-Network Pharmacies
Your pharmacy network is made up of a nationwide network of contracting pharmacies. If you use an in-network pharmacy, your out-of-pocket costs may be lower than if you use a pharmacy not in the network.
If you use an in-network pharmacy in 2018:
- Copays/coinsurance amounts will apply to the in-network out of pocket spending amounts
- Pharmacy costs will apply to the in-network deductible (if your plan has one)
- Pharmacy costs will be lower
If you use an out-of-network pharmacy in 2018:
- Copays/coinsurance amounts will apply to the out-of-network and out-of-pocket spending amounts
- Pharmacy costs will apply to the out-of-network deductible (if your plan has one)
- Any additional charges you may pay will not apply to any of the out-of-pocket spending amounts (based on your plan)
- Pharmacy costs may be higher
More Pharmacy Benefit Information
Talk with your doctor, or pharmacist, about any questions or concerns you have about medicines you are prescribed. Coverage is based on the limitations and exclusions of your benefit plan. For some medicines, members must meet certain standards before prescription drug benefit coverage may be approved. Remember, pharmacy and treatment decisions are always between you and your doctor. Only you and your doctor can decide which medicine is right for you.
Answers for Your Questions
If you are a BCBSOK member, you have many ways to learn more about your pharmacy benefits:
Members with a health plan provided through their employer will see these changes on their 2018 plan renewal date, unless otherwise listed. ↵
This change will not be made for Blue Preferred Silver PPO 101 – Three $0 PCP Visits. ↵
Preferred Pharmacy Network pricing isn’t available for 100% cost-sharing plans. These 100% cost-sharing plans don’t have a tiered structure for member out-of-pocket copay/coinsurance for prescription drugs. ↵
You can also fill up to a 90-day supply at a retail pharmacy in the Preferred Pharmacy Network. ↵