prescription

Your Prescription Isn’t Covered – Now What?

Any time your doctor prescribes a drug, it’s natural to have some questions—not just about how to take the medication, but also about the costs. Is it covered under your plan? What will your copay be? If it’s not covered, what are your options? The answers to those questions vary based on your plan and prescription, but our pharmacy team has advice no matter your scenario.

If a prescription is rejected, you will want ask the pharmacy why it wasn’t covered. They will be able to tell you the reason and maybe let you know some alternative drugs that are covered by your plan. Then you should talk to your doctor about that medication and see if you can take an alternative one instead.

To avoid surprises at the pharmacy or to see if there’s a generic version of a brand-name drug you’re currently taking, check your drug list on bcbsm.com. You can also log in to your member account at bcbsm.com or use the Blue Cross app to check coverage information and the price of a prescription.

If you have issues or concerns with a prescribed drug that isn’t covered, call the number on the back of your member card and talk to the customer service team. With pharmacy-related questions, such as those about prior authorization or your prescription drug coverage, you will be redirected to a member of the Blue Cross pharmacy team who can help.

It’s important to know that our top priority is our members’ health. When we determine what to cover, we always go with the safest, most effective drugs that provide the best value to our members. Drug manufacturers set prices for their products and we don’t receive advanced notice of increases. Blue Cross pharmacists monitor these prices so members always have access to safe, high-quality prescription medications. We also actively track when generic drugs become available, so members can take advantage of these lower cost options. It’s also important to remember drug lists vary based on your plan, and coverage varies based on your employer’s benefit package.  

For more information on pharmacy coverage and care, check out these other blogs:

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