Members

Using Your Pharmacy Benefits

Pharmacy Program Advantages

Your pharmacy benefits are administered through the Arkansas Blue Cross and Blue Shield Pharmacy Program, which eliminates paper claim forms and employs the latest technology for electronic pharmacy claims processing. When you fill your prescription at a participating pharmacy, the Pharmacy Program computer network instantly alerts the pharmacist to the following:

  • Any potential harmful interaction of the medication about to be dispensed with any other medication that the patient may already be taking;
  • Whether this medication may duplicate another medication the patient is taking;
  • Whether the prescribed dosage or strength is appropriate for the age of the patient.

These features help you save money and promote good health and safety.

Common Prescription Benefit Structures

Standard Formulary (Drug List) (PDF)

The Standard Formulary is a listing of covered medications and the corresponding copayment tier under which the medication is listed. The specific dollar amount of copayment for each medication will vary depending upon your policy benefits, but the tier assignment for the medication will be the same for all members. Look on your health-plan ID card or drug card to determine the dollar amounts of your copayments. In general, the three copayment levels are:

First tier: Almost all generic medications (lowest copayment of all tiers)

Second tier: Preferred brand-name medications and other lower-cost, brand-name medications (mid-level copayment)

Third tier: High-cost medications or medications classified as non-preferred (highest level of copayment)

Metallic Drug List (PDF)

The Metallic Drug List corresponds to our Gold, Silver, and Bronze products that are qualified health plans (QHP). The specific dollar amount of copayment for each medication will vary depending upon your policy benefits, but the tier assignment for the medication will be the same for all members.

First tier: Preventative medications defined by Health Care Reform that member can obtain for $0 cost to the member

Second tier: Almost all generic medications

Third tier: Preferred brand-name medications and other lower-cost, brand-name medications

Fourth tier: High-cost medications or medications classified as non-preferred

Fifth tier: Specialty drugs that may require either special handling and/or storage and may be only purchased through a select specialty pharmacy.

Value Formulary (Drug List) (PDF)

The Value Formulary promotes cost savings through using more generic medications and over the counter products rather than branded prescription drugs. The specific dollar amount of copayment for each medication will vary depending upon your policy benefits, but the tier assignment for the medication will be the same for all members.

First tier: Almost all generic medications

Second tier: Preferred brand-name medications and other lower-cost, brand-name medications

Third tier: High-cost medications or medications classified as non-preferred

Fourth tier: Member obtains medication at the health plan's discounted rate and member pays the entire cost of the medication

How Are Medications Added to the Formulary (Covered Drug List)

The Arkansas Blue Cross Pharmacy and Therapeutics Committee makes recommendations regarding preferred and non-preferred medications. The committee includes:

  • Arkansas physicians in private practice;
  • Medical directors from Arkansas Blue Cross and Health Advantage;
  • Community pharmacists in private practice;
  • Pharmacy directors of major Arkansas hospitals;
  • Arkansas Blue Cross/Health Advantage Pharmacy Director

For More Information

If you need more information about your prescription drug coverage, call 1-800-863-5561.