What is a “tier,” and how does it work?
Our drug lists are divided into categories, called “tiers.” The safest and least expensive drugs are included in the lower tiers. Your copay, or out-of-pocket cost, is based on a drug’s tier. To find out what your out-of-pocket costs for a drug will be, check your drug rider. BCBSM and Blue Care Network members can see your drug rider by logging in to your account at bcbsm.com.
My prescription isn’t covered. What should I do?
First, talk with your doctor about alternatives that are on our drug list. Have your doctor contact the BCBSM or BCN Pharmacy Help Desk to request approval for a drug. Alternatively, you can contact Customer Service to initiate a request. With some benefit plans, certain drugs aren’t covered at all. In those cases, you would pay the full cost of the drug.
What is prior authorization and why is it important to me?
Some drugs on our lists require approval before we’ll cover them. That’s because we want to ensure that you’re getting the most appropriate, cost-effective drug for your condition. You may need to meet certain requirements or try one or more preferred drugs before we’ll approve the covered drug that you are requesting. Drugs that require approval are identified in your drug list.
What do I need to know about drug interactions?
Drugs can interact and cause serious side effects. For example, if a woman is taking oral contraceptives and also takes certain antibiotics, the contraceptives may not be effective at preventing pregnancy. It’s important that you talk with your doctor about all of the medications you are taking – including over-the-counter medications and medications prescribed by other doctors. You may want to bring all of this information to your next doctor visit. This will help ensure that the drugs you’re taking will work as intended. Also, make sure you carefully read the information that comes with your medications and take them as prescribed.
For more health insurance tips visit bcbsm.com/101 or follow the hashtag #Covered101 on our social channels. If you have a specific question, please submit your query online through our Customer Action Center.
Photo Credit: Charles Williams