Prescription Drug Programs
Prime Therapeutics is your Pharmacy Benefit Manager (PBM).
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.
https://www.bcbsil.com/docs/rx-drugs/drug-lists/il/rx-list-bal-il-2024.pdf
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.
The following link is a list of preventive medications available in ALL Egyptian Trust health plans with no member cost share as per the Affordable Care Act (ACA). This list includes only drugs available on the Balanced Drug List.
If you are enrolled in Plan D – HDHP the following link includes an expanded list of drugs that may be available and not subject to the plan deductible. For these drugs you will pay the copay amount indicated on the Plan D Summary of Benefits prior to your deductible being satisfied. Drugs that are flagged as “ACA” are preventive drugs that may be covered at 100% with no member cost share. Important Note: This list is not limited to only drugs available on the Balanced Drug list. Please also check the Balanced Drug List linked at the top of this page to ensure the drug is covered by the Egyptian Trust Plan D.
Standard HDHP-HSA Common Preventive and Maintenance Medications
Certain contraceptives are covered with no member cost share. To identify the appropriate no cost share alternatives available in the Egyptian Trust health plans, see the Contraceptives section (under Endocrine and Metabolic Drugs) in the Balanced Drug list linked at the top of this page. The no cost contraceptives are flagged with a mark in the ACA column.
Home Delivery (mail order) service is a convenient way to have your maintenance medications delivered directly to you and can save you money. As of January 1, 2023, it is mandatory to fill all 90-day maintenance BRAND medications through mail order. Members can view the Rx90 Maintenance Drug List to determine if their maintenance medication is subject to mandatory mail order. Brand name drugs are listed in all CAPITAL letters.
Click on the following link for more information regarding mail order:
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. View these documents for more information about Specialty Pharmacy.