The best way to avoid surprises at the pharmacy is to know what your Blue Cross Blue Shield of Michigan Medicare plan covers and how much it will pay toward a drug. You can find that information in your plan's drug list, also called a formulary.
In our plan formularies, drug names are either in capitals or lowercase italic type. In general, these mean:
You can better understand the cost of a prescription by looking at its drug tier.
Drug tiers are how we classify prescriptions into how much they'll cost. You can find what tier your drug is in on your plan's drug list.
Although what you pay depends on your plan, drug tiers can give you a general idea of cost. Here's how they work:
Tier 1 includes commonly prescribed generic versions of brand-name drugs with the lowest copay.
Tier 2 drugs are generics with a higher copay. They still save you money over the brand-name versions.
Tier 3 prescriptions are mostly brand-name drugs with a lower copay or cost than drugs in Tier 4.
Tier 4 drugs generally have lower-cost alternatives available in other tiers, so your copay or cost may be higher.
Tier 5 drugs are high-cost generic and brand-name drugs. They require special handling or administration, so they tend to be the most expensive. They're often injections or infusions done in a medical setting.
The drug list also tells you about any special rules for a prescription. They're especially important because if you don't follow them your plan might not pay its share of the cost.
Here are three common abbreviations you'll find:
QL stands for quantity limits. It means that your plan will only pay for a certain amount of pills every so many days. For example, your plan might only pay for 180 pills every 90 days.
ST stands for step therapy. Step therapy means trying certain medications before trying another drug for your condition.
PA stands for prior authorization. This means that we need to approve the prescription before you get it filled.