Blue Access for Producers

Three-tier Formulary Copayment

Product Summary
The three-tier formulary copayment program is designed to save members and employers money through utilization of lower-priced generic and formulary brand drugs obtained through contracting pharmacies. Contractual arrangements with pharmacies may lower the price members pay for prescription drugs. Any resulting cost savings can then be passed onto employers through lower claim costs.

Easy Copayments and Contracting Pharmacies
Flexibility in plan design gives employers a choice in copayments. The copayments selected allow members to know in advance the cost of their prescription when they use a contracting pharmacy. The copayment (e.g. $10, $15 or $30) depends on whether the medication is generic, formulary brand or non-formulary brand. Blue Cross and Blue Shield has contracted with more than 99 percent of Illinois pharmacies and more than 56,000 pharmacies nationwide.

The Formulary
The formulary is a list of preferred drugs selected by a nationally recognized panel of physicians and pharmacists. Medications are evaluated on their comparative efficacy, safety, uniqueness and cost effectiveness. The formulary is updated quarterly, and generic medications are added as they become available.

Non-HMO Mail Service Prescription Drug Program
The mail service benefit gives members the convenience and cost-savings of having a 90-day supply of a maintenance medication delivered to their home. Copayments for mail service medications are two times the retail copayment amount.

HMO 90-Day Supply Program
The 90-day supply program gives members the option to obtain a 90-day supply of maintenance medications at a retail pharmacy or through a mail service pharmacy. Members can save both time and money when using a 90-day supply contracting pharmacy for their maintenance medications. Copayments for a 90-day supply are two times the 34-day supply copayment amount.