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INDIVIDUAL & FAMILY

Your Pharmacy Plan Benefits

Time to pick up your prescription from a Montana pharmacy? There are some important things to know. Find your covered prescriptions, ways to save and next steps with your doctor or pharmacist.

Pharmacist talks with her customer

Prescription Changes

Understand How Your Prescription Drugs May Change

Each year, our annual drug lists change. Starting Jan. 1, 2025, your prescription may have:

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Moved to a higher or lower drug tier

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Added to or removed from the drug list

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Changed special requirements 

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 Plan's Drug Lists

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

Do You Need to Take More Steps?

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 or pre-approval, this means your doctor will have to get approval from BCBSMT before your plan will cover the medicine.
  • Dispensing limits: Drugs with dispensing limits may only be covered for a certain amount filled at a time.
  • Step Therapy: If your benefit plan includes a step therapy program, you may need to try another medicine first before your drug may be covered.

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.