What happens at the pharmacy?
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.
Which pharmacies can I use?
With more than 66,000 network pharmacies to choose from, it's easy to find one that's near you.View the list
of national retail chains and independent drug stores in South Carolina. You should always check with your pharmacy to see if it is part of our network before you have your prescriptions filled.
How much will I pay for my drugs?
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.
What is a generic drug?
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 FDA requires that their active ingredients be the same. To learn more about generic drugs, talk to your doctor or pharmacist.
Are generic drugs safe?
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.
Is there a generic drug available for me?
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.
What are specialty drugs?
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.
What are drug management programs?
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. Current BlueChoice members: Even if you currently have an approval for a drug in one of the drug management programs, you may need to get a new authorization to continue to have coverage for that drug.
What is mail service?
Another way you can get your prescriptions filled is by using mail service. 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.