Any questions about your pharmacy benefit can be answered by calling Member Services. Just call the number on the back of your member ID card.

Drug Tiers

Your Cost Drug Tier Usually Includes
$ Tier 1 Lowest-cost prescription generic and some over-the-counter drugs.
$$ Tier 2 Prescription generic and some over-the-counter drugs.
$$$ Tier 3 Brand-name drugs that don't have a generic available. Also may include higher priced generics that have more cost-effective options at lower tiers.
$$$$ Tier 4 Brand-name drugs that have brand or generic options at lower tiers. Also may include higher-priced generics that have more cost-effective options at lower tiers.
$$$$$ Tier 5 Specialty drugs* that are more cost-effective than other specialty drugs that treat the same conditions. Also may include some non-specialty brand or generic drugs that have more cost-effective options at lower tiers.
$$$$$$ Tier 6 Specialty drugs that have more cost-effective alternatives at Tier 5. Also, may include some non-specialty brand or generic drugs that have more cost-effective options at lower tiers.

*Specialty drugs are prescription medications that are used to treat complex or chronic medical conditions, such as cancer, rheumatoid arthritis, multiple sclerosis and hepatitis C.

Please note that if a plan has a brand deductible, any tier 3 or tier 4 medication will process to that deductible before applying benefits.

Vaccines

Effective immediately, you can get your seasonal flu vaccine covered at $0 copay through your pharmacy benefit by visiting any network pharmacy. Find a participating pharmacy with our Pharmacy Locator, or you can visit your primary care physician. Don't have a primary care physician? Find one here.

You can also visit a participating pharmacy within South Carolina or the entire U.S. to get some non-seasonal preventive care vaccines at $0 copay. A chart of these vaccines is as follows:

Vaccine Min. Age Max. Age
HAEMOPHILUS B --- 6 years
HAEMOPHILUS B POLYSAC CONJ-HEPATITIS B (RECOMB) VACCINES --- ---
HEPATITIS A (INACTIVATED)-HEPATITIS B (RECOMBINANT) VACCINE --- ---
HEPATITIS A VACCINE --- ---
HEPATITIS B VACCINE --- ---
HEPATITIS B VACCINE RECOMB ADJUVANTED PREF SYR 20 MCG/0.5ML --- 18 years 
HEPATITIS B VACCINE RECOMBINANT ADJUVANTED 20 MCG/0.5ML --- 18 years 
HUMAN PAPILLOMAVIRUS (HPV)  9 years 26 years
MENINGOCOCCAL --- ---
MENINGOCOCCAL (C & Y)-HAEMOPHILUS B TETANUS TOX CONJ VACCIN 2 months 8 months
PNEUMOCOCCAL --- ---
POLIOVIRUS VACCINE, INACTIVATED POLIO VACCINE (IPV)  --- 17 years 
ROTAVIRUS VACCINE, LIVE ORAL --- 8 months
TOXOID COMBINATIONS --- ---
VARICELLA VIRUS VACCINE LIVE --- ---
VIRAL VACCINE COMBINATIONS --- ---
ZOSTER VAC RECOMBINANT ADJUVANTED FOR IM INJ 50 MCG/0.5ML 50 years ---

Maintenance Drugs

Maintenance drugs are prescription drugs that are taken on a long-term basis. They may be used to treat a chronic condition or may be products taken routinely, such as birth control pills. Prescriptions for these products often can be filled for 90 days at a time. Some health plans may require 90-day fills for maintenance drugs. 

Some common maintenance drug categories or conditions include:

  • ADHD
  • Alzheimer’s disease
  • Asthma and COPD
  • Blood clots and blood clot prevention
  • Benign prostatic hyperplasia (BPH)
  • Breast cancer prevention
  • Cholesterol or lipid lowering
  • Constipation
  • Contraceptives
  • Depression
  • Diabetes
  • Elevated thyroid hormone
  • Fibromyalgia
  • Glaucoma
  • Gout
  • Heart failure
  • High blood pressure
  • Hormone replacement
  • Inflammatory bowel disease
  • Irritable bowel disease
  • Neuropathic pain
  • Osteoporosis
  • Overactive bladder
  • Parkinson’s disease
  • Potassium replacement
  • Rheumatoid arthritis
  • Seizures
  • Stroke and heart attack prevention
  • Testosterone replacement
  • Thyroid hormone replacement
  • Ulcers, heartburn and reflux
  • Vitamins