YOUR HEALTH
Prescription Plan
Your prescription drug coverage is included with your medical plan coverage and is managed by BCBSTX/Prime Therapeutics. You have access to pharmacy chains such Walgreens, Walmart, HEB, Kroger and many more. Remember that CVS pharmacies, CVS pharmacies in Target stores and some independent pharmacies are not part of the BCBSTXC/Prime Therapeutics network. To find a full list of in‑network pharmacies, log in to www.MyPrime.com and click on “Find a Pharmacy.”
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| PPO, Premier CDHP and Basic CDHP Plan | ||||
| Prescription Drug Tier | Retail (31-Day Supply) |
Retail (90-Day Supply) |
Express Scripts Mail Order (90-Day Supply) |
Accredo Specialty Pharmacy (30-Day Supply) |
| Preferred Generic | $5 | $15 | $10 | n/a |
| Non-Preferred Generic | $20 | $60 | $40 | n/a |
| Preferred Brand Name | $40 | $120 | $80 | n/a |
| Non-Preferred Brand Name | $80 | $240 | $160 | n/a |
| Preferred Specialty Drugs | 10% of cost up to $300 maximum | n/a | n/a | 10% of cost up to $300 maximum |
| 2 grace fills only | ||||
| Non-Preferred Specialty Drugs | 20% of cost up to $600 maximum | n/a | n/a | 20% of cost up to $600 maximum |
| 2 grace fills only | ||||
Preferred/Non-Preferred Specialty Drugs are used in the treatment of medical conditions such as hepatitis, hemophilia, multiple sclerosis and rheumatoid arthritis. Specialty drugs may be oral, topical or injectable medications that can either be self-administered or administered by a health care professional. Specialty drugs can be dispensed at the retail pharmacy for two grace fills. Thereafter, they must be dispensed through Accredo Specialty via mail order for a 31-day supply.
For a current list of specialty medications and coverage, visit www.accredo.com/BCBSTX or call 833.721.1619.
Home Delivery (Mail Order Program)
For maintenance medications used for chronic conditions like high cholesterol, high blood pressure, asthma, and diabetes, you can fill a 90-day prescription through home delivery. Your prescription will be mailed straight to your home, saving you a trip to the pharmacy. You will receive 90 days’ worth of medication for a price of 60 days.
To start using home delivery or find more information, you can contact Express Scripts by three different ways:
- Online and mobile. Visit www.esrx.com/BCBSTX
- By phone. Call 1.833.715.0942.
- By Physician. Create an account at www.esrx.com/BCBSTX and have your doctor contact Express Scripts Pharmacy directly at 1.888.327.9791 for prescriber instructions. Make sure you provide your doctor with your member card.
90-Day Retail Prescription Drug Program
Powell offers a 90-Day Retail prescription drug program through the Advantage Extended Supply Network from Prime Therapeutics. This program offers you the convenience of filling your maintenance medications once every 90 days at a participating retail pharmacy. The network has more than 45,000 pharmacies to choose from, including Walgreens and Kroger. To see if your pharmacy is in the network, or to find a new pharmacy, log in to www.MyPrime.com, then click on “Pharmacies.”
Resources
Group #: 079163
877-794-3574
| PPO, Premier CDHP and Basic CDHP Plan | ||||
| Prescription Drug Tier | Retail (31-Day Supply) |
Retail (90-Day Supply) |
Express Scripts Mail Order (90-Day Supply) |
Accredo Specialty Pharmacy (30-Day Supply) |
| Preferred Generic | $5 | $15 | $10 | n/a |
| Non-Preferred Generic | $20 | $60 | $40 | n/a |
| Preferred Brand Name | $40 | $120 | $80 | n/a |
| Non-Preferred Brand Name | $80 | $240 | $160 | n/a |
| Preferred Specialty Drugs | 10% of cost up to $300 maximum | n/a | n/a | 10% of cost up to $300 maximum |
| 2 grace fills only | ||||
| Non-Preferred Specialty Drugs | 20% of cost up to $600 maximum | n/a | n/a | 20% of cost up to $600 maximum |
| 2 grace fills only | ||||