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Blue RxSM Preferred 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 59,000 pharmacies throughout the United States participate in the Catalyst Rx network that supports Blue Rx Preferred*
  • 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 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 Preferred 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

Please note: This information is only a summary of the benefits of Blue Rx Preferred 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, 2nd Quarter, 2007

 


Copyright© 2008 Wellmark, Inc. All Rights Reserved.
Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association doing business in Iowa and South Dakota. Blue Cross®, Blue Shield®, and the Cross® and Shield® symbols are registered marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.


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