3-tier Prescription Drug Plan (Blue Rx Complete)
To determine if a drug is covered, you must consult the Wellmark Blue Rx Complete Drug List. You are covered for drugs on the aforementioned list. If a drug is not on the list, it is not covered.
|Tier 1: Generic Drugs||25% coinsurance|
|Tier 2: Preferred Name Brand Drugs||30% coinsurance|
|Tier 3: Non-preferred Name Brand Drugs||50% coinsurance|
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.
Self-administered, self-injectable specialty drugs are covered under your medical insurance with 10% co-insurance.
Out-of-Pocket Maximums for Prescription Drugs
There is a separate out-of-pocket maximum (OPM) for prescriptions drugs under the SHIP plan. 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|
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.
Created to be the same as an existing approved name brand drug in dosage form, safety, strength, quality and performance characteristics.