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INDIVIDUAL & FAMILY

Your Pharmacy Plan Benefits

When it’s time to pick up your prescription from a Montana pharmacy, you may have a few ways to save.

Pharmacist talks with her customer

PRESCRIPTION COSTS

Understand Your Prescription Costs

Your prescription costs depend on a few things, like if you've met your deductible and what your prescription's drug tier is.

You'll pay the cost of your prescription until you meet your plan's annual deductible. Then, you'll pay an out-of-pocket amount depending on your drug's tier. Medicines are broken into their tiers depending on if they're preferred or nonpreferred, generic or brand name and specialty or nonspecialty drugs. To check if your medicine's covered and its tier, explore the annual drug lists.

PRESCRIPTION SAVINGS

Take Steps to Lower Your Drug Costs

DRUG TIERS

Check Your Prescription's Drug Lists

Depending on your plan, you’ll have a 4 tier list or a 6 tier list. Search the drug lists find your medicine’s drug tier.

Search Drug Lists
Woman showing her phone to a pharmacist.

UNDERSTANDING TIERS

How Prescription Tiers Work

Your health plan’s prescription drug list has a few levels of coverage, called member payment tiers.

Depending on your plan, you’ll have 4 tiers or 6 tiers. Each tier has its own cost with lower tiers normally costing less. You can find your medicine's drug tier when you check the drug list.

Doctor writing a script.

ADDITIONAL REQUIREMENTS

Are There More Steps to Get Your Prescription?

Sometimes, you or your doctor might need to take extra steps to get your prescription. Your drug list will show you if your prescription requires you to take any of these extra steps:

  • Prior authorization: Sometimes called preauthorization, this means your doctor will have to get approval from BCBSMT to prescribe a medicine.
  • Dispensing limits: Drugs with dispensing limits can only be prescribed at a certain quantity or lower.
  • Step Therapy: If your benefit plan includes a step therapy program, you may need to try medicines not in the program first.

Member Account

Review Your Pharmacy Benefits

Visit Blue Access for Members℠ to find in-network pharmacies, check your Rx benefits and more.

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FAQs

Common Questions About Pharmacy Benefits

1 Not all prescriptions can be filled in a 90-day supply and may need to be filled at select retail pharmacies or via home delivery. Based on your plan benefits, you may not save on your out-of-pocket costs but will spend less time going to the pharmacy.