Now you can view the 2018 Covered Drug List to see if we cover your prescription drugs. With Blue Option, you have access to a wide variety of prescription drugs. Our goal is to give you a choice of safe and effective drugs, while also keeping your drug costs affordable.
Print a 2018 copy of our covered drug list.
You should always check with your pharmacy to see if it is part of our network before you have your prescriptions filled.
Please note our network of pharmacies, Advanced Choice Network, became effective 10/1/16. With more than 55,000 network pharmacies to choose from, it's easy to find one that's near you! This network offers access to a wide variety of pharmacy options, including all CVS/pharmacy, Walmart, Kroger and Safeway locations, plus many grocers and independent pharmacies. Please be sure to view a new comprehensive list of South Carolina pharmacies as well as a new list of all national retail chains and some independent pharmacies in South Carolina. Note that filling prescriptions at a pharmacy that is not in the Advanced Choice Network will require you to pay full price. Please note this network excludes Walgreens.
Effective immediately, you can get your seasonal flu vaccine covered at $0 copay through your pharmacy benefit by visiting a CVS pharmacy. Find a participating CVS pharmacy within South Carolina. Or, you can visit your primary care physician. Don't have one? Find one here.
You can also visit a participating CVS pharmacy within South Carolina or the entire U.S. to get some non-seasonal preventive care vaccines at a $0 copay. Here is a chart of these vaccines:
|Adults||Children (birth to age 18)|
|Measles, Mumps, Rubella||X||X|
|Tetanus, Diphtheria, Pertussis||X||X|
|Measles, Mumps, Rubella, Varicella||X|
Zoster (Zostavax and Shingrix)*
|Tetanus, Diphtheria Toxoids||X|
|Hepatitis A & B||X|
*This vaccine is only covered for those ages 60 and older.
You will notice that the tiers look slightly different. That's because in 2016, there will be six tiers instead of four tiers.
Tier 0: These drugs are considered preventive medications under the ACA and we cover them at no cost to you.
Tier 1: Drugs on this tier are usually preferred generic drugs. They will typically cost the least amount of money out of your pocket.
Tier 2: Drugs on this tier are usually generic drugs. They will typically cost less than brand drugs.
Tier 3: Drugs on this tier are usually preferred brand drugs. They typically cost less than other brand drugs.
Tier 4: Drugs on this tier are usually non-preferred brand drugs. They typically cost more than other brand drugs and may have generic equivalents
Tier 5: Drugs on this tier are usually preferred specialty drugs that are used to treat complex conditions. They are typically very expensive.
Tier 6: Drugs on this tier are usually specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.
NOTE: Specialty medications are not available through the mail-order program for a 90-day supply. This only applies to generic or brand drugs in these tiers.
You will take your prescription to a network pharmacy and give it to the pharmacist, along with your member ID card. The pharmacist will use a computer to check your benefits and determine the amount you pay for prescriptions. The computer will also alert your pharmacist if there are any special requirements that apply to your prescription, such as a drug management program. If you don’t present your ID card or you don’t use a network pharmacy, you’ll have to file a claim for your purchase and you may not be reimbursed for the full amount you paid.
When you use a participating pharmacy, the amount you pay depends on the specific plan you have and your medication. Depending upon your plan, you may have a copayment (a set dollar amount) for each prescription or you may pay a percentage of the cost for each prescription (coinsurance). Some of our plans may require that you pay a deductible (an amount you pay before your insurance starts to pay) before any coinsurance percentage is applied. See your schedule of benefits for more information.
A generic drug is a drug that’s identical to its brand-name counterpart in dosage, safety, strength, quality, the way it’s used and the condition it’s used to treat. Generics become available when patents expire on brand-name drugs. The color and shape of a generic drug may be different from its brand-name counterpart, but the Federal Drug Administration (FDA) requires that their active ingredients be the same. To learn more about generic drugs, talk to your doctor or pharmacist.
Absolutely! The FDA approves all generics and holds them to the same high safety standards as brand-name drugs. And best of all, generics will usually cost you less than brand-name drugs.
Most likely. There are generics available to treat many conditions, and many commonly prescribed drugs have generic versions. In fact, nearly eight out of every 10 prescriptions are now filled with generics.
Specialty drugs treat conditions like cancer, hepatitis, multiple sclerosis or rheumatoid arthritis, to name a few. You will have a higher copayment for specialty drugs. Specialty drugs that you take by mouth or self-inject will have to be filled by our preferred specialty pharmacy for you to have payment under your plan. Also, some specialty drugs require prior authorization. Your specialty prescriptions will be delivered directly to your home.
They are quality programs that promote the safe use of medications. Prior authorization requires your doctor to get prior approval for some medications. Quantity and dose management limit the amounts of some medications that we cover each month. Step therapy asks you to try alternative medications before we provide benefits for some medications.
Another way you can get your prescriptions filled is by using mail order. This is used for prescriptions that you take on an ongoing basis. You can get up to a 90-day supply at a time if your doctor writes the prescription that way. One advantage is that your prescriptions are delivered conveniently to your home.