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Group Prescription Drug Plans

To purchase prescription drug coverage, groups must also purchase health care coverage. For groups with more than 100 contracts, we will customize a prescription drug plan to meet your needs.

Groups should contact one of our regional sales offices.

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Blue Cross Blue Shield of Michigan

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Preferred Rx

Preferred Rx is a pharmacy PPO and our most cost-effective prescription drug program. Members have easy access to more than 98 percent of the pharmacies in Michigan and over 90 percent of the pharmacies in the United States.

Preferred Rx offers very competitive discounts on brand-name drugs and features our Maximum Allowable Cost program for generic drugs. Members pay only a copayment, if required, when they use Preferred Rx participating pharmacies.

Preferred Rx groups can choose to add the following options to their plans:

• Home Delivery (Mail Order) — Members receive postage-paid envelopes and may purchase up to a three-month supply, which results in savings on copayments.
• 90-Day Retail — Members can receive up to a 90-day supply of medication at participating 90-day retail pharmacies. All chain pharmacies and most independent pharmacies in Michigan participate in this program. Download the 90-Day Retail Pharmacy List (PDF) for a list of participating pharmacies by city.
  
  The 90-Day Retail option is currently only available to groups 100+. If your group is enrolled in a BCBSM mail order plan, please note that the 90-day retail program is only compatible with your MOPD or MOPD 2X (mail order) copayment option. In addition, your 90-day retail copayment must match your current mail order copayment.

BCBSM's Preferred Rx prescription drug program offers access and quality through cost controls, large pharmacy networks and the following features:

• Copayment Options — Flat-dollar, fixed-percentage and variable-dollar copayment options for members.
• Cost Savings — Price discounts from network pharmacies and reimbursement levels well below average wholesale prices.
• Drug Formulary — Helps physicians identify cost-effective therapies that provide high-quality care for eligible plan members.
• Drug Utilization Review — Concurrent, retrospective and prospective reviews that identify potential savings as well as inappropriate use or abuse.
• Online Drug Adjudication System — Links participating pharmacies in Michigan to BCBSM database. Pharmacists have instant access to benefits, eligibility and potential drug interaction information before dispensing prescriptions.

Blue Preferred Rx — Flat Dollar Copayment Plans

Benefit Plan	Copayment		Minimum Enrollment
	Generic	Brand	Sponsored	Area
$10/$20	$10	$20	2+	2+
$10/$40	$10	$40	2+	2+
$10/$60 with MAC program	$10	$60	2+	2+
$15/$30	$15	$30	2+	2+
$15/$50 with MAC program	$15	$50	2+	2+

Blue Preferred Rx — Triple-Tier Copayment Plans

Benefit Plan	Copayment			Minimum Enrollment
	Tier 1	Tier 2	Tier 3	Sponsored	Area
$15/$30/$60	$15	$30	$60	2+	2+

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Blue MedSave

Blue MedSave, a medical savings account, uses funds set aside by either an employer or employee to cover physician and hospital expenses. MSAs use pre-tax dollars and are available to small businesses with up to 50 employees. Blue MedSave includes the Blue Advantage Rx Plan, which is a member discount program for prescription medications and separate from the medical/surgical coverage.

After a patient receives medical care, funds from the MSA are used to pay the deductible. When the person reaches the deductible maximum, the health insurer processes the claim and makes payment. Remaining monies in a MSA are rolled over to pay for medical costs in subsequent years.

Blue MedSave is available to small businesses that purchase a Comprehensive Major Medical plan through professional and trade associations or BCBSM-sponsored chambers of commerce.

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Other BCBSM Prescription Drug Plans

Benefit Plan	Description	Minimum Enrollment
		Sponsored	Area
50%	Blue Preferred Rx with 50% copay. 50% copayment for each prescription, but not less than $10 or more than $100	2+	2+
Blue Advantage	Allows members to purchase eligible drugs and supplies from network pharmacies at reduced rates by showing their BCBSM identification card.	2 - 50	NA

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Benefit Plan	Deductible	Copayments			Minimum Enrollment
		Formulary Drugs		Nonformulary Drugs
		Tier 1	Tier 2	Tier 3	Sponsored	Non-Sponsored
$5/$30	None	$5	$30	Not covered	2+	2+
$5/$30 - 2x mail order copay	None	$5	$30	Not covered	2+	2+
$5/$50	None	$5	$50	Not covered	2+	2+
$5/$50 - 2x mail order copay	None	$5	$50	Not covered	2+	2+
$10/$20	None	$10	$20	Not covered	2+	2+
$10/$20 - 2x mail order copay	None	$10	$20	Not covered	2+	2+
$10/$40	None	$10	$40	Not covered	2+	2+
$10/$40 - 2x mail order copay	None	$10	$40	Not covered	2+	2+

Flat Dollar Copayment Plans with Deductibles

Benefit Plan	Deductible	Copayment			Minimum Enrollment
		Formulary Drugs	Nonformulary Drugs
		Tier 1	Tier 2	Tier 3	Sponsored	Non-Sponsored
$5/$30 with deductible	$200/$400	$5	$30	Not covered	2+	2+
$5/$30 - 2x mail order copay and Rx deductible	$200/$400	$5	$30	Not covered	2+	2+
$5/$50 with deductible	$200/$400	$5	$50	Not covered	2+	2+
$5/$50 - 2x mail order copay and Rx deductible	$200/$400	$5	$50	Not covered	2+	2+
$10/$20 with deductible	$200/$400	$10	$20	Not covered	2+	2+
$10/$20 - 2x mail order copay and Rx deductible	$200/$400	$10	$20	Not covered	2+	2+
$10/$40 with deductible	$200/$400	$10	$40	Not covered	2+	2+
$10/$40 - 2x mail order copay with Rx deductible	$200/$400	$10	$40	Not covered	2+	2+

Percent and Triple Tier Copayment Plans

Benefit Plan	Deductible	Copayment			Minimum Enrollment
		Formulary Drugs		Nonformulary Drugs
		Tier 1	Tier 2	Tier 3	Sponsored	Non-Sponsored
50%	None	$5	$30	Not covered	1+	2+
50% - 2x mail order copay	None	$5	$30	Not covered	1+	2+
$5/$15/$25	None	$5	$50	Not covered
$5/$15/$25 - 2x mail order copay	None	$5	$50	Not covered
$10/$20/$40	None	$10	$20	$40	2+	2+
$10/$20/$40 - 2x mail order copay	None	$10	$20	$40	2+	2+