PRESCRIPTION DRUG COVERAGE OPTIONS

Prescription Drug Coverage is provided based upon the health plan offered each employee group. 

Blue Cross/Blue Shield Michigan Custom Formulary Quick Guide for Members

2011 Prescription Drug Information

Employee Group (non-grandfathered Plan) AC,AH, AP, CC, FA, PT AND VF

PPO Option 3 & Option 4

Retail Pharmacy (Triple Tier Plan)

Tier 1 - $5 generic prescription drugs

Tier 2 - $25 for preferred brand name drugs listed on the BCBSM Custom Formulary

Tier 3 - $50 for non-preferred brand name drugs with the highest co payment

Mail Order – 90 day supply (2x Co-payments)

Tier 1 - $10 generic prescription drugs

Tier 2 - $50 for preferred brand name drugs listed on the BCBSM Custom Formulary

Tier 3 - $100 for non-preferred brand name drugs with the highest co payment

Retail Pharmacy – 90 day supply (2 Co-payments)

Tier 1 - $10 generic prescription drugs

Tier 2 - $50 for preferred brand name drugs listed on the BCBSM Custom Formulary

Tier 3 - $100 for non-preferred brand name drugs with the highest co payment

Employee Group (grandfathered Plan) CP, CS, FM, LE AND PS

PPO Option 1 & Option 2

Retail Pharmacy (Triple Tier Plan)

Tier 1 - $10 generic prescription drugs

Tier 2 - $20 for preferred brand name drugs listed on the BCBSM Custom Formulary

Tier 3 - $30 for non-preferred brand name drugs with the highest co payment

Mail Order – 90 day supply (2x Co-payments)

Tier 1 - $20 generic prescription drugs

Tier 2 - $40 for preferred brand name drugs listed on the BCBSM Custom Formulary

Tier 3 - $60 for non-preferred brand name drugs with the highest co payment