Pharmacy Benefits

All of our health plans include comprehensive prescription drug coverage designed to reduce your out-of-pocket costs. No matter which health plan you choose, you'll have access to a wide range of medications and an extensive pharmacy network.
  • Easy access: choose from a wide range of network pharmacies when getting your prescriptions filled
  • Savings: lower your out-of-pocket costs by using Prime Mail. You could have a a 90-day supply of medications delivered to your door step for the cost of just 2.5 copayments for tiers 1 through 2, and 3 copayments for tier 4 medications. You’ll also save a trip to the pharmacy
  • Convenience: get your specialty pharmacy medications through Walgreens Specialty Pharmacy. They’ll be delivered to the location you specify

What is a formulary?

A formulary is simply a list of drugs that are covered by your insurance. The BCBSRI formulary is divided into five tiers. Each tier has a corresponding copayment, depending on your health plan.

The Five Tiers

  • First Tier: includes generic prescription drugs that have the lowest copayment
  • Second Tier: includes higher cost generics
  • Third Tier: includes higher-cost generics and preferred brand name prescription drugs
  • Fourth Tier: includes the highest-cost generic drugs and non-preferred brand name drugs
  • Fifth Tier: includes specialty prescription drugs that have the highest copayment. Click here for more information.

2017 formulary

2016 formulary

NOTE: Some drugs require a prior authorization. (That’s different from the prescription.) Your doctor will fill out and submit the form. You can view the guidelines and form on our Commercial Formulary page.

Quantity Limits

Certain drugs can only be filled to a set quantity at one time. There is a List of Drug Quantity Limits for each formulary.

Pharmacy Claims

If you pay for a prescription out of pocket, you can submit a Prescription Drug Claim Form for reimbursement according to your plan.