Starting January 1, 2021, some prescription drugs:
If you’d like to see if your medication is impacted1, you can review 2021 prescription drug list changes.
When viewing your drug list, if you see a mark in the additional requirements columns, here's what they mean:
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. Your pharmacy benefit has up to 6 payment tiers.
Most often, the lower the tier, the lower your out-of-pocket costs will be for the drug.
You could be paying more – or less – for your drug based on the 2021 tier.
Here's a list of some drugs that are no longer covered as of January 1, 2021.2
If your prescription drug is on the list, you'll see other drug alternatives that may be options for you.
Here’s your 2021 drug list (for coverage that renews or starts on or after January 1, 2021):
$0 HDHP-HSA Preventive Drug List (This applies only for Blue Preferred Bronze PPOSM 502 plan)
You can save money by using an in-network pharmacy. Your out-of-pocket costs are often generally lower at an in-network pharmacy.
At a preferred 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 the 2021 network, visit myprime.com.
Please note, changes could be made to the pharmacies in the future.
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).
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.
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 Commonly used drugs that are no longer covered may not apply to all strengths/formulations. Third-party brand names are the property of their respective owners. Drugs that have not received U.S. Food and Drug Administration (FDA) approval are not covered.
3 The preferred pharmacy network pricing isn't available for 100% cost-sharing plans.