Prescription Drug
If you enroll in one of the Aegis Living medical plans with Premera Blue Cross you will automatically have prescription drug coverage. Premera partners with Express Scripts to manage the prescription drug coverage.
How Will My Prescriptions Be Covered?
Our medical and prescription drug plans follow the Essentials 1 and Essential 4 drug formulary. Follow these steps to find out how your prescriptions will be covered:
2. Scroll down to the “Search as a visitor” section
3. Select E1/E4 from the “Drug list to search” drop down menu
4. Enter a drug name or select a therapeutic class to search
5. When you find the drug you are looking for, look at the “Status” column in the chart and refer to the “Definition of Status” description.
Once you are enrolled, you can search the Essentials E1 formulary for the Core and Buy Up Plans and the E1 network for the Low Cost Plan through your Premera member portal.
Filling Your Prescription Drugs
If you elect medical coverage under either of the Premera Blue Cross plans, you automatically receive prescription drug coverage. You can fill prescriptions:
-
At Premera Blue Cross participating retail pharmacies
At non-participating retail pharmacies, but you will need to pay full-price for the drugs and submit a claim form for reimbursement.
Mail Order
You can also choose to order prescriptions through Premera’s Mail Order Program. With the mail order program you can receive a 90-day supply of medication for only 2 ½ (rather than three times the 30-day copay). Mail order offers other features including refill reminders and automatic screening for interaction with other prescription medications you order from the mail order program.
-
Refill reminders
-
Automatic screening for interaction with other prescription medications you order from the mail order program
-
Licensed pharmacists on call 24 hours a day to answer questions
The Mail Order Program can be reached at 1-800-391-9701 or www.premera.com
Preventive Medications Covered at No Cost (Core and Buy Up Plans Only)
Certain preventive medications are covered at no cost to you in-network. The Core and Buy-Up Plans uses the PV Lite preventive drug list. There are certain preventive medications/vaccinations that will be covered in full depending on your age and diagnosis. Medications on the E1 formulary, when you search on line, will be marked with ACA PV to indicate if they are covered at 100%. Mail order is also available and it is mandatory home delivery for maintenance drugs. In addition to preventive drugs mandated by the Affordable Care Act (ACA), certain hypertension, diabetes, cholesterol lowering, asthma, osteoporosis, and antidepressant medications will be covered by all plans at no cost. Once enrolled, register on premera.com to view more information about prescription drugs.
SaveonSP – For Individuals Who Use Specialty Pharmacy
In general, specialty drugs are drugs typically used to treat chronic, complex or rare conditions and may require enhanced clinical support. If you enroll in the Core or Buy-Up Plans and take certain specialty medications, you will be contacted by the SaveonSP program with the opportunity to enroll. Once enrolled, your qualified specialty Rx copays will be covered at no cost to you. If a member chooses not to enroll, they will have to pay the maximized copay for specialty Rx included in the program. Not all specialty prescription drugs are included.
Core and Buy-Up Plans: If you elect a brand name drug when a generic equivalent is available, you will be charged the brand name copay, plus the difference in cost between the brand name and generic drug, unless indicated by the prescriber.