Understand Your Pharmacy Benefits

Based on your health plan, your prescription drug costs may depend on if you’ve met your in-network deductible.  

First, you’ll pay your prescription’s full cost upfront until you meet your in-network deductible. After you’ve met your in-network deductible, you’ll pay an out-of-pocket cost of a copay or coinsurance for covered prescription drugs. Your out-of-pocket costs are based on the drug’s tier and your plan benefits. 

Illustration Understand Pharmacy Benefits
Illustration Help Lowering Cost

Help With Lowering Your Costs

You may keep your prescription drug costs down if you:

  • Fill your prescriptions at an in-network pharmacy
  • Ask your doctor if a covered alternative is an option
  • Get up to a 90-day supply of covered drugs used regularly1

Remember, pharmacy selections and your care are always between you and your doctor.

Ask your doctor if you have questions or concerns about your medications.

How Prescription Tiers Work

Your health plan’s prescription drug list has many levels of coverage, called member payment tiers.  

Some plans have up to 4 tiers and some plans have up to 6 tiers. Each tier has its own cost. Most often, the lower the tier, the lower your out-of-pocket costs will be for the drug.  

When you get a prescription, you can look up the drug tier on your drug list.

Understanding and Using Your Drug List

After you meet your annual in-network deductible, you’ll pay for your prescription based on its tier on the drug list.  

When you look up your prescription drugs, seeing the drug tier lets you know if you’ll pay lower or higher out-of-pocket costs. It can also show you if your prescription drugs have any additional requirements.

Illustration Drug Lists

Prescription Drug Lists and Costs

Find your medication and learn more about viewing drug costs online:

2023 Individual and Family Health Plans

2023 6 Tier Drug List

2023 4 Tier Drug List

2023 $0 HDHP-HSA Preventive Drug List (This applies for Blue Advantage Plus BronzeSM 501 plan) 

Learn About Additional Requirements

Some drugs listed in the drug list may have additional requirements. This means there may be extra steps to take before getting your prescription filled.

Icon Prior Authorization

Prior Authorization

In some cases, your doctor will need to send us a pre-approval request before your prescription drug may be covered.

Icon Step Therapy

Step Therapy

You may need to first try a more cost-effective drug before some other drug may be covered.

Icon Dispensing Limits

Dispensing Limits

You may only be able to get a certain amount of your drug at one time. Review drug dispensing limits

Icon Specialty Pharmacy Program

Specialty Pharmacy Program

You may need to get a specialty drug at an in-network specialty pharmacy. Some drugs may be filled in a smaller amount (split fill), letting you try them at a prorated cost first. Review specialty pharmacy program details

More Suggestions For You

Icon Scheduling Appointment

Scheduling Your Annual Exam

Icon What to Expect After Applying

Understand Health Care Plans

Icon Useful Tools

Useful Tools and Resources


1 Not all prescriptions can be filled in a 90-day supply and may need to be filled at select retail pharmacies or via home delivery. Based on your plan benefits, you may not save on your out-of-pocket costs but will spend less time going to the pharmacy.