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FAQ: Prescription drugs

Yes, prescription drugs are covered for all of the individual health plans offered by Independence Blue Cross. Please refer to your individual plan details for more information on covered prescription drugs.

The prescription drug benefits program is administered by FutureScripts®, an independent pharmacy benefits management company. The FutureScripts network includes more than 68,000 retail pharmacies, including most national and regional chain pharmacies and many neighborhood pharmacies. Some plans utilize the FutureScripts Preferred Pharmacy Network.

Each time you go to a participating pharmacy to fill a prescription, simply present your Independence Blue Cross ID card. How you will be charged will depend on your plan type:

  • Standard prescription drug plans: You will pay either the copay or coinsurance specified for the generic, Preferred brand, Non-preferred drug, or self-administered Specialty drug you have been prescribed. If your health plan has a maximum copay amount, that means that Independence Blue Cross will cover any expenses beyond that amount for a particular prescription and you only need to pay that maximum copay amount. If you use an out-of-network pharmacy, then you will be required to pay 70 percent coinsurance.
  • HSA Qualified plans: HSA health plans have a prescription deductible that is integrated with the medical deductible. This means that you pay for prescriptions in full until your medical deductible has been reached. Once the deductible has been met, you are covered (at the appropriate cost sharing) for generic drug, Preferred brand, Non-preferred drug, or self-administered Specialty drugs from in-network pharmacies. If you use an out-of-network pharmacy, then you will be required to pay 70 percent coinsurance, after deductible.
  • High Deductible Health Plans (HDHP): Personal Choice EPO Bronze Basic and the Personal Choice EPO Catastrophic plan also have a prescription deductible that is integrated with the medical deductible. This means that you pay for prescriptions in full until your medical deductible has been reached. Once the deductible has been met, you are covered (at the appropriate cost sharing) for generic drug, Preferred brand, Non-preferred drug, or self-administered Specialty drugs from in-network pharmacies. On these plans, there is no coverage for out-of-network pharmacies and you will be required to pay the full cost of the prescription.

No. In accordance with health care reform provisions effective October 1, 2010, all of our plans have unlimited prescription drug benefits.

A generic drug is comparable to a brand drug in form, dosage, strength, how it works, and how it is used. A brand drug has a patented marketing name. Learn more about generic vs. brand-name drugs and how you could save on prescription drugs.

Yes. Depending on the plan you select, you may be able to get a 90-day supply for the cost of a 60-day supply when using the mail order service. To get started with mail-order service, log in to ibx.com. Learn more about getting a 90-day supply at Walgreens at ibx.com/walgreens.

Yes. Birth control pills (oral contraceptives) and injectable contraceptives are examples of women’s preventive, wellness health services under the list of Essential Health Benefits and many are covered 100 percent by Independence Blue Cross health plans.

The drug formulary is a list of medications that have been selected by Independence Blue Cross for their medical effectiveness, positive results, and value. The formulary includes all generic medications and a defined list of brand medications. You maximize your benefits when you purchase formulary medications.

The Independence Blue Cross Pharmacy and Therapeutics Committee, which meets regularly, may amend the formularies and Preferred drug lists quarterly — in January, April, July, and October. Plan participants and physicians who will be affected are notified of these changes.

This 59,000-pharmacy network is a smaller version of our full FutureScripts pharmacy network. Pharmacies that are not part of the Preferred network are considered non-participating or out-of-network pharmacies. The FutureScripts Preferred Pharmacy Network allows us to achieve greater cost savings, and ultimately a lower premium for the member.

The FutureScripts Preferred Pharmacy Network is included on the following plans for 2020:

  • Keystone HMO Gold Proactive
  • Keystone HMO Silver Proactive
  • Keystone HMO Silver Proactive Lite
  • Keystone HMO Silver Proactive Select1
  • Keystone HMO Silver Proactive Value1
  • Keystone HMO Silver
  • Personal Choice® PPO Silver
  • Personal Choice EPO Silver Reserve
  • Keystone HMO Bronze1
  • Personal Choice PPO Bronze
  • Personal Choice EPO Bronze Reserve
  • Personal Choice EPO Bronze Basic
  • Personal Choice Catastrophic

With this Preferred network, members will continue to have access to more than 59,000 pharmacies, such as Walgreens, CVS, Walmart, and Target, in addition to independent pharmacies.

To locate a participating pharmacy, use the Provider Finder at ibx.com. You can also call us at 1-888-678-7012 (TTY:711).

To locate a participating pharmacy, use the Provider Finder at ibx.com. You can also call us at 1-888-678-7012 (TTY:711).

Yes, many of our health plans feature a low member cost-share for certain designated prescription drugs at participating retail and mail order pharmacies.2 Your cost for these drugs would be $4 for a 30-day supply, or $8 for a 90-day supply via mail order. Generic drugs are as safe and effective as brand-name drugs and they could cost less. Learn more about the Low-cost Generic Program.

  • Keystone HMO Gold Proactive
  • Keystone HMO Gold
  • Personal Choice PPO Gold
  • Keystone HMO Silver Proactive
  • Keystone HMO Silver Proactive Lite
  • Keystone HMO Silver Proactive Select1
  • Keystone HMO Silver Proactive Value1
  • Keystone HMO Silver1
  • Personal Choice PPO Silver
  • Keystone HMO Bronze1
  • Personal Choice PPO Bronze

The Value Formulary provides a comprehensive list of medications that include generics, brands, and specialty drugs that have been evaluated for their medical effectiveness, positive results, and value. Drugs may not be covered when there are good alternatives used to treat the same condition at a lower cost. The 4-tier formulary is based on a defined list of generic, Preferred Brand, Non-preferred drug, and self-administered Specialty prescription drugs. The 5-tier formulary is based on a defined list of low-cost generics, other generics, Preferred Brand, Non-preferred, and Specialty drugs. The only difference between the 4-tier and 5-tier Formularies is the low-cost generic drugs.

The following plans utilize 5-tier formularies:

  • Keystone HMO Gold Proactive
  • Keystone HMO Gold
  • Personal Choice PPO Gold
  • Keystone HMO Silver Proactive
  • Keystone HMO Silver Proactive Lite
  • Keystone HMO Silver Proactive Select1
  • Keystone HMO Silver Proactive Value1
  • Keystone HMO Silver1
  • Personal Choice PPO Silver
  • Keystone HMO Bronze1
  • Personal Choice PPO Bronze

The Mandatory Generic Program encourages the use of affordable, effective generic drugs. If the plan participant chooses to purchase a brand drug that is available in generic form, they will be responsible for paying the dispensing pharmacy the difference between the negotiated discount price for the generic drug and the brand drug plus the appropriate cost-sharing for a brand drug.

Copay Discounted cost You pay
Generic $20 $100 $20
Brand $60 $300 $260 (Discounted cost of brand - discounted cost of generic + copay)

  • Keystone HMO Gold Proactive
  • Keystone HMO Silver Proactive
  • Keystone HMO Silver Proactive Lite
  • Keystone HMO Silver Proactive Select1
  • Keystone HMO Silver Proactive Value1
  • Keystone HMO Silver1
  • Personal Choice PPO Silver
  • Personal Choice EPO Silver Reserve
  • Personal Choice EPO Silver Reserve Select1
  • Keystone HMO Bronze1
  • Personal Choice PPO Bronze
  • Personal Choice EPO Bronze Reserve
  • Personal Choice EPO Bronze Basic1
  • Personal Choice EPO Catastrophic

Yes. You have access to Non-preferred drugs; however, you pay less when you select Preferred or generic medications. You maximize cost savings when selecting a generic drug.

You can review this information on the Plan Comparison page. Simply expand the plan details and click “Search for a drug” under the Prescription Drug section.

Some prescription drugs require special permission to obtain before your doctor can dispense them to you. If you need a drug that requires prior authorization, your doctor will take care of the paperwork. You may even receive a portion of your medication for free while the prior authorization is processed.

This information can be found within the Drug Formulary Look-up tool as well as within the Procedures that Prescription Drug Guidelines document. The form is also available through Independence Blue Cross Customer Service.

The preventive medication program provides complete coverage for certain preventive medications when provided by a participating retail or mail-order pharmacy.2 Coverage includes certain generic and brand medications within the following drug categories, as described in the Patient Protection and Affordable Care Act:

  • Aspirin for adults age 50-59 to prevent cardiovascular disease; low dose (81mg) for women after 12 weeks gestation who are at high risk for preeclampsia
  • Breast cancer chemo prevention for women
  • Fluoride supplementation for children 6 months thru 6 years
  • Folic acid supplementation for women planning or capable of pregnancy
  • Lovastatin (40mg or less) for cardiovascular disease prevention in adults age 40-75 with no history of cardiovascular disease
  • Tobacco interventions for adults who use tobacco products

These certain designated preventive medications will not be subject to any cost-sharing or deductibles, but will be subject to the terms and conditions of plan participant’s benefits contract, including age and gender requirements.

All covered self-administered Specialty medications except insulin will be provided through the convenient Specialty Pharmacy Program for the appropriate cost sharing. Benefits are available for up to a thirty (30) days supply. You can take advantage of the FutureScripts Specialty Pharmacy. Through FutureScripts Specialty Pharmacy, you will receive:

  • 24/7 video consultations. Pharmacists are available anytime via secure web video to answer questions, provide medication self-administration training, and help members follow personalized treatment plans.
  • Ongoing patient education and support. Members receive educational materials and FutureScripts Specialty Pharmacy staff communicate with a member’s other health care providers regarding follow-up, when appropriate, in order to help them manage their condition more effectively.
  • Confidential, convenient order and delivery. Order medications by phone for delivery anywhere in the U.S. with no shipping charges.
  • Refill reminders. Members receive a phone call before their medication refill date to schedule next delivery and help them adhere to their treatment without disruption.
  • Members can realize additional cost savings because FutureScripts Specialty Pharmacy provides better discounts on most specialty drugs compared to pricing at retail pharmacies.

Certain specialty medications must be filled through FutureScripts Specialty Pharmacy; these are called limited distribution drugs. Speak with your prescribing Specialist and ask if the specialty drug you are taking is a limited distribution drug.

Getting started with the Specialty Pharmacy Program is easy. Once enrolled in an Independence Blue Cross plan, simply call the pharmacy number on the back of your member ID card, select 1 for members, and follow the phone menu prompts for Specialty Pharmacy.

1 Keystone HMO Silver Proactive Select, Keystone HMO Silver Proactive Value, Keystone HMO Silver, and Keystone HMO Bronze are not available for purchase through the Federal Health Insurance Marketplace and must be purchased through Independence directly.

2 Prescriptions may also be available for up to a 90-day supply at participating FutureScripts Act 207 retail pharmacies for the same mail order member cost. To learn more about mail order services and Act 207 pharmacies, contact FutureScripts at the number on the back of your ID card.