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Blue RxSM 3-Tier Plans
Three Levels of Payment
The amount you pay for prescriptions depends if the drug is on the
first, second or third tier on the Wellmark Drug List.
- You'll have
the lowest cost share for drugs on the first tier (generic drugs)
- You'll
have an intermediate cost share for drugs on the second tier (specially
selected brand name drugs)
- You’ll have the highest cost share for drugs
on the third tier (all other brand name drugs)
In addition, if you
choose a Tier 2 or Tier 3 drug when an A-rated generic is available,
in most cases you will pay your cost share and the difference
in costs
between the generic and brand name drug.
How It Works
- Ask your physician if the drug is generic. If it isn’t,
ask whether a generic equivalent drug is available
- Ask your
physician to refer to the Wellmark Drug List. Your
copayment is lower for first or second tier drugs
- Choose a pharmacy that contracts with Catalyst Rx. More than 60,000
pharmacies throughout the United States participate in the Caremark
network that supports Blue Rx*
- To find a participating pharmacy, use our
online
directory
- Show your Wellmark ID card to the pharmacist
each time you have a prescription filled. You will automatically
get the lowest price available to Wellmark covered members
at
that pharmacy
- Pay the pharmacist only your share of the cost of the prescription.
The pharmacist will submit the claim for you and be reimbursed for his or
her portion
What You Get
1. Nationwide pharmacy network.
The Catalyst Rx network that supports Blue Rx is one of the most
expansive pharmacy networks in the country.
2. No claim forms to fill out.
When you present your Wellmark ID card
at participating pharmacies, your claims are submitted automatically while
your prescriptions are being filled! No paper claims. No hassles.
3. Cost savings.
Presenting your Wellmark ID to the pharmacist
before the prescription is filled ensures that you pay only your share
of the costs.
4. Wellmark Drug List.
Our drug list, a comparative listing
of drugs, helps manage the overall cost of prescription medications by
promoting the use of more cost-effective drugs. Search
the Wellmark
Drug List.
5. Benefits at out-of-network pharmacies.
Even if an out-of-network pharmacy
is used, you still have benefits. However, these pharmacies do not have
benefit information available. You will have to pay for the drugs at
the time the prescription is filled and fill out and submit a paper claim.
You will be reimbursed the amount a participating pharmacy would have
received.
Questions About Your Specific Benefits
- Refer to your benefits certificate, coverage manual, or policy
- Call the Customer Service
number on your identification card
*Catalyst Rx, 1st Quarter, 2009
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.
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