Prescription Coverage
What you need to know
With this plan, there is no deductible for prescription drugs. Cost sharing begins immediately and applies until you meet the separate prescription drug out-of-pocket limit for this plan.
Filling Your Prescriptions
You can get short-term prescriptions (30 days or less) at a network pharmacy; to get medications you take regularly, you must use home delivery from Express Scripts® Pharmacy or a participating Smart90 Anywhere Retail Pharmacy, or Kaiser mail order if you’re a Kaiser participant.
Find a pharmacy:
- BCBSNM and UnitedHealthcare participants, click here (registration and log in to Express Scripts is required)
- Kaiser participants, click here (click on search doctors, then select pharmacies)
What You Pay
| Prescription Drug Out-of-Pocket Limit* | A separate out-of-pocket limit applies $1,500 per individual, up to $5,950 combined for all family members |
| Retail Pharmacy (up to 30-day supply) or Accredo specialty mail order (up to 30-day supply) | |
|---|---|
| Generic / specialty generic | $0 for many preventive medications Other generic medications: 20% ($5 min / $10 max) |
| Preferred brand / specialty preferred brand | 30% ($30 min / $45 max) |
| Non-preferred brand name / specialty non-preferred brand | 40% ($50 min / $75 max) |
| Express Scripts Mail Order or Express Scripts Smart90 Anywhere (90-day supply), Kaiser Mail Order (100-day supply) | |
| Generic | $0 for many preventive medications Other generic medications: 20% ($12.50 min / $25 max) |
| Preferred brand | 30% ($75 min / $112.50 max) |
| Non-preferred brand name | 40% ($125 min / $187.50 max) |
* The cost of out-of-network prescription drugs purchased outside of the program is covered at 50% and does not apply toward the out-of-pocket limit.
**Maintenance medications purchased outside of the Smart90 Anywhere participating pharmacy will be billed at the full cost after the first two months of refills. Remember to submit a 90-day script or request the 90-days from the pharmacy (if available). See Benefit Summaries for details.
Contacts and Resources
Go to the Get to Know Our Benefit Providers page for details.
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