Members
Using your pharmacy benefits
Need to find what’s covered under your plan or looking for a drug list or pharmacy?
Be sure to register for Blueprint Portal , where you can access all pharmacy-related information specific to your plan. You’ll find information about what’s covered under your pharmacy plan and associated costs, your pharmacy claims history, and in-network pharmacies.
Important terms to know
- Coinsurance is the member’s share of the cost of a prescription after a deductible is met.
- Coinsurance with a copay requires the member to pay a copayment for the drug and an additional percentage of the discounted cost of the drug.
- Copay is a fixed amount you pay for a prescription.
- Deductible is what a member pays before the member’s health insurance plan starts to pay.
- Formularies are lists of covered medications. Find your formulary on Blueprint Portal or the resources page .
- Generic medications are lower-cost alternatives to brand-name medications. Generics are chemically identical to brand-name medications and must pass the same safety standards.
- High Deductible Health Plan/Health Savings Account (HDHP/HSA) will get the benefit of the plan's discounted drug prices when using their prescription drug card. Those member's costs will be credited to the member's annual deductible and out of pocket limits.
- Individual and family out-of-pocket maximums are when you’ve paid the maximum amount after all deductibles, coinsurance, and copays have been met. If a plan covers one person, there is an individual maximum. If multiple people are covered under the same plan, then there is a family maximum.
- Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medications. Examples include medications used to treat high blood pressure, asthma, or diabetes.
- Preferred brand drugs are certain brand-name drugs that may be cost-effective if a generic medication is unavailable.
- Preventive medications are prescribed to help one stay healthy. Depending on the plan, these medications may be free or low cost to the member.
- Prior authorization means that before a prescription is filled, it’s reviewed to ensure it’s clinically appropriate before the insurance company pays its share of cost.
- Specialty medications typically require defined handling and home storage demands, crucial patient education and careful monitoring. Some specialty drugs can be obtained only from specialty pharmacies. Noted as SGM on formularies.
- Step therapy uses prescription medications by first using generic drugs to treat conditions and then moving to brand-name or higher-cost medications only if the generic medications are ineffective. More information can be found here.
- Tiers are levels of a plan’s coverage for prescriptions based on the types of drugs covered under the plan. Check your specific plan’s tiers of coverage.
Check out the resources section for additional info.