Prescription Drug Programs
Prime Therapeutics is your Pharmacy Benefit Manager (PBM) as of March 1, 2019.
Prime Therapeutics maintains the Balanced Drug List (also known as a prescription drug list) and manages a network of retail pharmacies.
The Balanced Drug List is a list of drugs available to Blue Cross and Blue Shield of Illinois (BCBSIL) members. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list and the tier designation of the drug. Generally, if you choose a drug that is generic or preferred, your out-of-pocket costs will be less. Your doctor should consult the Balanced Drug List when prescribing drugs for you. This list is regularly updated as generic drugs become available and changes take place in the pharmaceuticals market.
Most major chain pharmacies participate in the Prime network except CVS pharmacies. If you are using an independent drugstore, you should confirm whether it participates in the network. To find out, visit www.myprime.com or call a Benefits Value Advisor (BVA) Customer Service Representative at 855-686-8517.
If you are enrolled in the HDHP Plan (Plan D) the following link will list those medications considered preventive under the prescription drug program. Medications on this list treating an ongoing medical condition will not be subject to the annual deductible. Instead, you will pay the copay amount as indicated on your Summary of Benefits. Medications on this list considered wellness or preventive will be paid at 100% with no member cost share. Click on the following link for a list of drugs which are considered preventive for HSA-eligible plans:
The following link is a list of preventive medications with no member cost share as per the Patient Protection and Affordable Care Act (PPACA). This list applies to all plans.
Contraceptives covered with no member cost share.
Specialty medications that require professional services for administration are usually covered under your medical benefit plan. Coverage for self-administered specialty medications is provided through your pharmacy benefit plan. The following link is a current list of specialty medications.