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Blue
RxSM
Blue Rx is a managed drug plan included with
several of our health plans. It’s a convenient program that helps members get all
their medically necessary prescription medications at the most economical price!
How It
Works
Blue Rx includes managed care elements that
balance two important goals: providing access to necessary medications and encouraging the
economical purchase of those medications. The incentives built into this plan and the
information we provide help accomplish these goals. Here’s how:
- Blue Rx encourages the use of generic drugs,
unless an "A" rated generic drug is not available. Members may choose to purchase a brand-name
drug even when a generic is available. However, the member will
usually pay a higher copayment or
coinsurance amount and the difference between the two drug prices.
- Blue Rx gives you lower costs because Wellmark has
negotiated a pricing structure through the member pharmacies that participate
in the Catalyst Rx network that supports Blue Rx. When members use
their ID cards at any of the participating pharmacies,
their claims will be processed electronically and they will automatically
get the lowest price available at that pharmacy.
Blue
Rx features include:
- Nationwide pharmacy network - The Catalyst Rx network
that supports Blue Rx is one of the most expansive pharmacy networks
in the country. Nationwide, more than 60,000 pharmacies are part of
the pharmacy network that supports Blue Rx.*
- No claims forms to fill out
- When members
present their Wellmark ID card at participating pharmacies, their claims
are submitted automatically to us while their prescriptions are being
filled. No paper claims. No hassles.
- Cost Savings - By
presenting their Wellmark ID to the pharmacist before the
prescription is filled, members will ensure that they pay only their
share of the costs. There’s no need to second-guess the amount.
- Wellmark Drug List - Our Wellmark
Drug List, a
comparative listing of drugs, helps manage the overall cost of
prescription medications by promoting the use of more cost-effective
drugs.
- Benefits at out-of-network
pharmacies - Even
if an out-of-network pharmacy is used, members still have Blue Rx
benefits. However, these pharmacies do not have benefit information
available. The member will have to pay for the drugs at the time the
prescription is filled and will need to file the claims directly with
Wellmark. Wellmark will reimburse the member the amount we would have
reimbursed a participating pharmacy.
Please note: This information is only a
summary of the benefits of Blue Rx coverage from Wellmark Blue Cross and
Blue Shield; it is to be used for descriptive purposes only. Benefits
and general provisions described
herein are subject to terms of the actual policy, benefits certificate,
or coverage manual.
*Catalyst Rx, 1st Quarter, 2009
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