What you will pay
When prescription drugs are purchased from pharmacies that are participating in the plan, the individual will either pay:
$7 or 25% of the amount charged, whichever is higher.
Out-of-Pocket Maximum (OPM)
The OPM expense provision for prescription drugs is separate from your medical OPM. The OPM refers to the maximum amount you will pay for most covered services during a calendar year. When the amount paid by the insured equals the OPM, the plan pays 100% of the maximum allowable fee for covered charges incurred during the remainder of the calendar year.
Student Only OPM = $1,000
Family OPM = $1,700
Generic vs. Preferred Name Brand Drugs
Generic Drugs are drugs that are created to be the same as an existing approved name brand drug in dosage form, safety, strength, quality and performance characteristics.
Preferred Name Brand Drugs are drugs that are on Wellmark’s preferred list.
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 important for you to have the brand name drug, they can write the prescription for the brand name drug with the direction “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.
ABOUT OUR SITE:
The information presented 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 you may contact Wellmark Blue Cross/Blue Shield at toll-free number 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.