The UISelect Pharmacy plan has a 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
Not Covered
The UISelect plan uses the BlueRX Value Plus formulary list. In addition, you may visit the Wellmark drug list to review which tier your specific medications fall under on the list.
- This plan does not cover drugs available as over-the-counter medicines without a prescription.
- Participating pharmacies are responsible for submitting your prescription claims electronically.
Specialty Pharmacy Requirement
UISelect members are required to use the UI Health Care Specialty Pharmacy for all their specialty drug needs.
UI Health Care Specialty Pharmacy has a personalized approach to assisting patients with specialty medication needs. This has resulted in above-average medication adherence, increased patient satisfaction, avoiding unwanted drug interactions, fewer hospitalizations, and better outcomes. UI Specialty Pharmacy also offers 24-hour pharmacy availability by phone and personalized assistance to patients in locating potential cost savings for specialty medications.
Find more information about the UI Health Care Specialty Pharmacy.
If you do not take specialty drugs, you will not need to do anything further. You do not need to transfer your prescriptions to UI Health Care pharmacies.
Specialty Pharmacy FAQ's
What are Specialty Drugs?
Medications that are high-cost injectable, infused, oral, or inhaled drugs for the ongoing treatment of a chronic condition. These drugs generally require close supervision and monitoring of the patient's drug therapy. Specialty drugs may be categorized within tiers on the formulary or as drugs covered under your medical benefit.
These drugs would treat conditions such as cancer, HIV/AIDS, Huntington's disease, infertility, inflammatory bowel disease, and liver diseases, including Hepatitis C and MS, organ transplants, cystic fibrosis, endocrine disorders, rheumatic diseases, and skin disorders.
What if I don't know if I am on a specialty drug?
You can visit the BlueRx Value Plus formulary list, which applies to the UISelect prescription coverage, and look for the name of the drug you are taking for treatment.
What is a Formulary Drug List?
A formulary drug list is a list of drugs covered under your pharmacy benefit and developed to guide physicians, pharmacists, healthcare professionals, and members in selecting cost-effective drug therapy.
The medications required to be filled by the UI Health Care Specialty Pharmacy are those listed as specialty drugs in the Formulary Drug List. UISelect uses the Blue Rx Value Plus Tier formulary.
Those drugs listed as SP-P and SP-NP would be specialty drugs required to be filled by the UI Health Care Specialty Pharmacy.
A small group of medications is covered under your UISelect benefits' medical portion rather than the pharmacy portion. These are labeled as "SP-M" on the BlueRx Value Plus Formulary. The following rules are helpful when trying to determine what you should do if you are taking an SP-M:
- You will not have to make any changes if you currently receive your "SP-M" medication at your doctor's appointment or an infusion center.
- If you give or will give your (SP-M) medication to yourself without assistance, it must be filled through UI Health Care Specialty Pharmacy.
If you have any questions, please reach out to the UI Health Care Specialty Pharmacy (319-384-6909) for assistance.
Where is the Specialty Pharmacy located at UI Health Care?
If you take specialty medications, you can choose any UI Health Care location within the hospital to pick up your prescription or mail it to your home.
UI Health Care pharmacy locations include:
- General Hospital
- Discharge Pharmacy
- Clinical Cancer Center
- Pomerantz Level 2 or Pomerantz Lower Level
- Iowa River Landing (IRL) Pharmacy
- River Crossing Pharmacy, located in Riverside, IA
Pharmacy Out-of-Pocket Maximum (OPM)
The OPM expense provision for prescription drugs is separate from the medical OPM. The insured is responsible for paying coinsurance on prescriptions (as described above) up to $2,450 for individuals or $4,900 for the family in prescription drug costs. Once the OPM has been met, the plan pays 100% of covered expenses incurred for drugs for the rest of the calendar year.
If you purchase a brand name drug when an FDA-approved “A”-rated generic equivalent is available, you are responsible for your coinsurance, plus any difference between the billed charge for the brand name drug and the billed charge for the generic. This can result in you paying substantially higher costs than if you had chosen the generic drug.
If your physician feels it is essential for you to have the brand-name drug, they can prescribe it with “Dispense as written” on the prescription. In this situation, you will not be responsible for the difference between the billed charge for the brand-name drug and the billed charge for the generic drug.
There are instructions on the Wellmark website on how to Request a Waiver of Brand if necessary.
Certain drugs are limited per month, benefit period, and lifetime by drug-specific quantity limitations, step therapy requirements, or prior authorization. Wellmark determines the limitations based on medical necessity. Visit the Wellmark website or check with your pharmacist or physician for a list of drugs subject to limitations.
Have a Question?
ABOUT OUR SITE:
Our website's information 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 - it can be found on the front of your card.