The UIChoice pharmacy plan (BlueRx Complete) has a four-tiered prescription benefit. This means you will pay coinsurance for each prescription, which will vary depending on the drug's tier (or category).
Tier 1 Drugs
Generic drugs
Tier 2 Drugs
Name-brand formulary drugs
Tier 3 Drugs
Non-formulary drugs
Tier 4 Drugs
Name-brand, non-formulary drugs
Is your drug covered?
UIChoice uses "BlueRx Complete" formulary list.
To review specific Wellmark formulary drug lists:
- Visit the Wellmark Prescription and Drug Lists webpage.
- Scroll down and choose the BlueRx Complete link under "View your formulary drug list."
- You will receive a pop-up box stating, "You are now leaving Wellmark.com." Select the "Continue to new site" button.
- You should now be on the Wellmark Drug Search webpage. You can enter the name of the drug or locate the name of the drug in the alphabetical list below the search bar in the upper lefthand corner of the webpage.
Note: Formulary Drug Lists are best viewed in Chrome.
- This plan does not cover drugs available as over-the-counter medicines without a prescription.
- Participating pharmacies are responsible for submitting your prescription claims.
Pharmacy Out-of-Pocket Maximum (OPM)
The prescription drug out-of-pocket maximum (OPM) is separate from the medical OPM. Once you reach the prescription drug OPM, the plan pays 100% of covered prescription drug expenses for the remainder of the calendar year.
Prescription Drug OPM Comparison
| Coverage Level | 2026 OPM | 2027 OPM |
|---|---|---|
| Single | $1,850 | $2,150 |
| Family | $3,700 | $4,300 |
You are responsible for paying prescription drug coinsurance until you reach the applicable OPM amount for your coverage level.
Brand-Name Drugs and Generic Alternatives
If you choose a brand-name drug when an FDA-approved "A"-rated generic equivalent is available, you will pay your coinsurance plus the difference between the cost of the brand-name drug and the generic drug. This may result in significantly higher out-of-pocket costs than choosing the generic drug.
If your physician determines that the brand-name drug is medically necessary and writes "Dispense as Written" on the prescription, you will not be responsible for the difference in cost between the brand-name drug and the generic drug.
Instructions for requesting a waiver of the brand-name requirement are available on the Wellmark website.
Prescription Drug Limitations
Some prescription drugs are subject to quantity limits, step therapy requirements, or prior authorization requirements. Wellmark determines these requirements based on medical necessity. Visit the Wellmark website or contact your pharmacist or physician to determine whether a medication is subject to these requirements.
ABOUT OUR SITE:
The information on our website describes only the highlights of the plans and does not constitute official plan documents. Additional terms and conditions may apply. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern. For more detailed information, contact Wellmark Blue Cross/Blue Shield at 800-524-9242 (TTY: 888-781-4262), Monday through Friday, from 7:30 a.m. to 5:00 p.m. (Central Time). For more efficient service, please have your member ID number handy - you can find it on the front of your card.