2024 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Section 5(f). Prescription Drug Benefits
Covered Medications and Supplies
Section 5. Benefits
Section 5(f). Prescription Drug Benefits
Covered Medications and Supplies
Note: For Standard Option, we state whether or not the calendar year deductible applies for each benefit listed in this Section. There is no calendar year deductible under Basic Option.
Benefits Description
Anti-hypertensive Medications
Preferred Retail Pharmacies:
Note: See Section 3 for information about drugs and supplies that require prior approval.
Standard Option - You Pay
Tier 1 (generic drug): $3 copayment (no deductible)
Basic Option - You Pay
Tier 1 (generic drug): $5 copayment for each purchase of up to a 90-day supply
Mail Service Prescription Drug Program:
Note: You must obtain prior approval before Mail Service will fill your prescription.
Note: See earlier in this section for Tier 2, 3, 4, and 5 prescription drug benefits.
Standard Option - You Pay
Tier 1 (generic drug): $3 copayment (no deductible)
Basic Option - When Medicare Part B is primary, you pay the following:
Tier 1 (generic drug): $5 copayment
Benefits Description
Anti-hypertensive Medications
Preferred Retail Pharmacies:
Note: See Section 3 for information about drugs and supplies that require prior approval.
Standard Option - You Pay
Tier 1 (generic drug): $3 copayment (no deductible)
Basic Option - You Pay
Tier 1 (generic drug): $5 copayment for each purchase of up to a 90-day supply
Mail Service Prescription Drug Program:
Note: You must obtain prior approval before Mail Service will fill your prescription.
Note: See earlier in this section for Tier 2, 3, 4, and 5 prescription drug benefits.
Standard Option - You Pay
Tier 1 (generic drug): $3 copayment (no deductible)
Basic Option - When Medicare Part B is primary, you pay the following:
Tier 1 (generic drug): $5 copayment