![]() ![]() Your prescription drug benefits through BCBSIL are based on a Drug List, which is a list of drugs considered to be safe and cost-effective. Your plan is a "metallic" health plan, which can include a Gold, Silver, Bronze or Catastrophic plan.You enrolled in a plan on your own (instead of through your employer) and.The drug lists below are used with your health plan if all of these apply to you: If you are taking or prescribed a drug that is not on your plan's Drug List, call the number on your member ID card to see if the drug may be covered by your medical plan. Examples of these drugs are contraceptive implants and chemo infusion. These drugs are often given to you in a hospital, doctor’s office or health care setting. These can include drugs that must be given to you by a health care provider. Some drugs are covered under your medical plan instead of your pharmacy benefits. ![]() Please note: Health plans may administer medical and pharmacy coverage separately for select drugs. If you have any questions about your prescription drug benefits, call the number on your member ID card. Be sure to review your benefit materials for details. If you are a BCBSIL member, log in to your Blue Access for Members SM, account to check your drug list and learn more about your prescription drug benefits. This may help lower your out-of-pocket costs. Your doctor should consult the Drug List when prescribing drugs for you. Generally, if you choose a drug that is a lower tier, your out-of-pocket costs for a prescription drug will be less. These prescription drug lists have different levels of coverage, which are called "tiers". How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. We continually monitor generic prices and market dynamics, and place medications –brand or generic – with the best overall health care value at the lowest possible tier.A drug list is a list of drugs available to Blue Cross and Blue Shield of Illinois (BCBSIL) members. In fact, there are instances where a generic can be more expensive than the brand and its other alternatives. High Cost Generics – While increasing use of generic drugs is one way to lower pharmacy costs, not all generics represent the best value.However, we understand exclusions can be disruptive for members – so we only make the decision to exclude a drug when it meets specific clinical and savings criteria. Exclusions – In situations where medications offer no additional clinical and/or financial value over other options in their class, exclusions may make sense.We proactively manage our PDLs using a variety of strategies including: Every drug is evaluated to determine how well it works, how it compares to others in its class, the total cost, and a number of other significant considerations to make sure that the medications with the highest health care value are affordable for your employees. ![]() ![]() Our PDL organizes all brand and generic prescription drugs into tiers based on Total Cost Management. That’s why our PDLs promote medications with the greatest health care value, regardless of brand or generic status. Many new drugs may cost more yet offer no additional health benefit. There are thousands of drugs available today and more coming to market every day. ![]()
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