Ask IBX
Have a question? Ask IBX! ASK
Ask IBX
Frequently Asked Questions

Frequently Asked Questions About Prescription Drugs & Coverage Benefits

Are Prescription Drugs Covered?

Yes, prescription drugs are covered for all of the individual health plans offered by Independence Blue Cross. Please refer to your individual plan details for more information on covered prescription drugs.

How Does My Prescription Drug Benefit Work?

The prescription drug benefits program is administered by FutureScripts®, an independent pharmacy benefits management company. The FutureScripts network includes more than 68,000 retail pharmacies, including most national and regional chain pharmacies and many neighborhood pharmacies. Some plans utilize the FutureScripts Preferred Pharmacy Network.

Each time you go to a participating pharmacy to fill a prescription, simply present your Independence Blue Cross ID card. How you will be charged will depend on your plan type:

  • Standard prescription drug plans: You will pay either the copay or coinsurance specified for the generic, preferred brand, non-preferred drug, or self-administered specialty drug you have been prescribed. If your health plan has a maximum copay amount, that means that Independence Blue Cross will cover any expenses beyond that amount for a particular prescription and you only need to pay that maximum copay amount. If you use an out-of-network pharmacy, then you will be required to pay 70 percent coinsurance.
  • HSA Qualified plans: HSA health plans have a prescription deductible that is integrated with the medical deductible. This means that you pay for prescriptions in full until your medical deductible has been reached. Once the deductible has been met, you are covered (at the appropriate cost sharing) for generic drug, preferred brand, non-preferred drug, or self-administered specialty drugs from in-network pharmacies. If you use an out-of-network pharmacy, then you will be required to pay 70 percent coinsurance, after deductible.
  • High Deductible Health Plans (HDHP): Personal Choice Bronze Basic and the Personal Choice Catastrophic plan also have a prescription deductible that is integrated with the medical deductible. This means that you pay for prescriptions in full until your medical deductible has been reached. Once the deductible has been met, you are covered (at the appropriate cost sharing) for generic drug, preferred brand, non-preferred drug, or self-administered specialty drugs from in-network pharmacies. On these plans, there is no coverage for out-of-network pharmacies and you will be required to pay the full cost of the prescription.

What Is the FutureScripts® Preferred Pharmacy Network?

Each time you go to a participating pharmacy to fill a prescription, simply present your Independence Blue Cross ID card. How you will be charged will depend on your plan type. The metallic level of your health plan will also impact your prescription costs. You can review the full benefit details at our benefits comparison page.

Is There a Maximum Prescription Drug Benefit?

No. In accordance with health care reform provisions effective October 1, 2010, all of our plans have unlimited prescription drug benefits.

What Is the Difference Between Generic and Brand-Name Medications?

A generic drug is comparable to a brand drug in form, dosage, strength, how it works, and how it is used. A brand drug has a patented marketing name. Learn more about generic vs. brand-name drugs and how you could save on prescription drugs.

Do My Benefits Include Mail-Order Service?

Yes. Depending on the plan you select, you may be able to get a 90-day supply for the cost of a 60-day supply when using the mail order service. To get started with mail-order service, log in to ibxpress.com.

Are Birth Control Pills Covered Under My Plan?

Yes. Birth control pills (oral contraceptives) and injectable contraceptives are examples of women’s preventive, wellness health services under the list of Essential Health Benefits and many are covered 100 percent by Independence Blue Cross health plans.

What Is a Drug Formulary?

The drug formulary is a list of medications that have been selected by Independence Blue Cross for their medical effectiveness, positive results, and value. The formulary includes all generic medications and a defined list of brand medications. You maximize your benefits when you purchase formulary medications.

How Frequently Does the Formulary Change?

The Independence Blue Cross Pharmacy and Therapeutics Committee, which meets regularly, may amend the formularies and preferred drug lists quarterly — in January, April, July, and October. Plan participants and physicians who will be affected are notified of these changes.

What Is the FutureScripts® Preferred Pharmacy Network?

This 50,000-pharmacy network is a smaller version of our full FutureScripts pharmacy network. Walgreens and Rite Aid are not included. Pharmacies that are not part of the Preferred network are considered non-participating or out-of-network pharmacies. The FutureScripts Preferred Pharmacy Network allows us to achieve greater cost savings, and ultimately a lower premium for the member.

The FutureScripts Preferred Pharmacy Network is included on the following plans for 2017:

  • Personal Choice® PPO Silver
  • Keystone HMO Silver
  • Personal Choice PPO Bronze
  • Keystone HMO Bronze2
  • Personal Choice PPO Bronze Reserve
  • Personal Choice Bronze Basic3
  • Keystone HMO Gold Proactive
  • Keystone HMO Silver Proactive
  • Keystone HMO Silver Proactive Value2
  • Personal Choice Catastrophic

What Pharmacies Are Excluded From the Preferred Pharmacy Network?

Compared to the FutureScripts network, there are two pharmacies excluded from the FutureScripts Preferred Pharmacy Network: Walgreens and Rite Aid. If a member elects to get a prescription filled at Walgreens or Rite Aid, it will be considered an out-of-network claim and the member will be responsible for the total upfront cost of their prescription drug(s) at the pharmacy, with the potential for partial reimbursement afterward via a paper claim submission depending on the plan design the member has selected.

How Many Pharmacies Are Available in the FutureScripts Preferred Pharmacy Network?

With this preferred network, members will continue to have access to more than 50,000 pharmacies, such as CVS, Walmart, and Target, in addition to independent pharmacies.

How Do I Find a Pharmacy in the FutureScripts Preferred Pharmacy Network?

To locate a participating pharmacy, use the Provider Finder at ibxpress.com. You can also call us at 1-888-678-7012 (TTY:711).

How Do I Find a Network Pharmacy?

To locate a participating pharmacy, use the Provider Finder at ibxpress.com. You can also call us at 1-888-678-7012 (TTY:711).

Are Low-Cost Generic Prescription Drugs Available?

Yes, many of our health plans feature a low member cost-share for certain designated prescription drugs at participating retail and mail order pharmacies.1 Your cost for these drugs would be $4 for a 30-day supply, or $8 for a 90-day supply via mail order. Generic drugs are as safe and effective as brand-name drugs and they could cost less.

Which Plans Offer Low-Cost Generics (also known as $4 Generic Program)?

  • Personal Choice PPO Gold
  • Keystone HMO Gold
  • Keystone HMO Gold Proactive
  • Personal Choice PPO Silver
  • Keystone HMO Silver
  • Keystone HMO Silver Proactive
  • Keystone HMO Silver Proactive Value2
  • Personal Choice PPO Bronze
  • Keystone HMO Bronze2

What Is the Difference Between the 4-Tier and 5-Tier Formularies?

The Select Drug Program® is based on an incentive drug formulary that includes all generic prescription drugs and a defined list of brand drugs that have been evaluated for their medical effectiveness, positive results, and value. The 4-Tier formulary is based on a defined list of generic, Preferred Brand, Non-Preferred drug, and self-administered specialty prescription drugs. The 5-Tier formulary is based on a defined list of preferred (low-cost) generics, other generics, Preferred Brand, Non-Preferred, and specialty drugs. The only difference between the 4-Tier and 5-Tier Formularies is the preferred generic drugs.

The following plans utilize 5-Tier formularies:

  • Personal Choice PPO Gold
  • Keystone HMO Gold
  • Keystone HMO Gold Proactive
  • Personal Choice PPO Silver
  • Keystone HMO Silver
  • Keystone HMO Silver Proactive
  • Keystone HMO Silver Proactive Value2
  • Personal Choice PPO Bronze
  • Keystone HMO Bronze2

How Does the Mandatory Generic Drug Program Work?

The Mandatory Generic Program encourages the use of affordable, effective generic drugs. If the plan participant chooses to purchase a brand drug that is available in generic form, they will be responsible for paying the dispensing pharmacy the difference between the negotiated discount price for the generic drug and the brand drug plus the appropriate cost-sharing for a brand drug.

 

Copay

Discounted cost

You pay

Generic

$20

$100

$20

Brand

$60

$300

$260 (Discounted cost of brand - discounted cost of generic + copay)

Scroll or swipe to reveal all table data.

Which Plans Include the Mandatory Generic Program?

  • Keystone HMO Gold Proactive
  • Personal Choice PPO Silver
  • Keystone HMO Silver
  • Keystone HMO Silver Proactive
  • Keystone HMO Silver Proactive Value2
  • Personal Choice PPO Bronze
  • Personal Choice PPO Bronze Reserve
  • Keystone HMO Bronze2
  • Personal Choice EPO Bronze Basic3
  • Personal Choice EPO Catastrophic

Does the Prescription Plan Cover Non-Preferred Drugs?

Yes. You have access to non-preferred drugs; however, you pay less when you select preferred or generic medications. You maximize cost savings when selecting a generic drug.

How Do I Know If My Prescription Drug Is Covered?

You can review this information on the Plan Comparison page of ibx4you.com. Simply expand the plan details and click “Search for a drug” under the Prescription Drug section.

What Is Prior Authorization?

Some prescription drugs require special permission to obtain before your doctor can dispense them to you. If you need a drug that requires prior authorization, your doctor will take care of the paperwork. You may even receive a portion of your medication for free while the prior authorization is processed.

How Do I Know If My Prescription Drug Requires Prior Authorization?

This information can be found within the Drug Formulary Look-up tool as well as within the Procedures that Support Safe Prescribing document. The form is also available through Independence Blue Cross Customer Service.

What Is the Preventive Medications Program and What’s Included?

The generic medication program provides complete coverage for certain preventive medications when provided by a participating retail or mail order pharmacy.1 Coverage includes certain generic and brand medications within the following drug categories, as described in the Patient Protection and Affordable Care Act:

  • Aspirin to prevent cardiovascular disease for men age 45-79 and women age 55-79
  • Breast cancer chemo prevention for women
  • Fluoride supplementation for children 6 months thru 6 years
  • Folic acid supplementation for women planning or capable of pregnancy
  • Iron supplementation for children ages 6 to 12 months who are at increased risk for iron deficiency anemia
  • Tobacco interventions for adults who use tobacco products
  • Vitamin D supplementation for ages 65 and over to prevent falls

These certain designated preventive medications will not be subject to any cost-sharing or deductibles, but will be subject to the terms and conditions of plan participant’s benefits contract, including age and gender requirements.

What Is the Specialty Pharmacy Program?

All covered self-administered specialty medications except insulin will be provided through the convenient Specialty Pharmacy Program for the appropriate cost sharing. Benefits are available for up to a thirty (30) days supply. You can take advantage of FutureScripts Specialty Pharmacy, BriovaRx. Through BriovaRx, you will receive:

  • 24/7 video consultations. Through BriovaLive, pharmacists available anytime via secure web video to answer questions, provide medication self-administration training, help them follow personalized treatment plans.
  • Ongoing patient education and support. Members receive educational materials and BriovaRx staff communicate with a member’s other health care providers regarding follow-up, when appropriate, in order to help them manage their condition more effectively.
  • Confidential, convenient order and delivery. Order medications by phone for delivery anywhere in the U.S. with no shipping charges.
  • Refill reminders. Members receive a phone call before their medication refill date to schedule next delivery and help them adhere to their treatment without disruption
  • Members can realize additional cost savings because BriovaRx provides better discounts on most specialty drugs compared to pricing at retail pharmacies

Certain specialty medications must be filled through BriovaRx; these are called limited distribution drugs. Speak with your prescribing Specialist and ask if the specialty drug you are taking is a limited distribution drug.

How Do I Get Started With the Specialty Pharmacy Program?

Getting started with the Specialty Pharmacy Program is easy. Once enrolled in an Independence Blue Cross plan, simply call the pharmacy number on the back of your member ID card, select 1 for members, and follow the phone menu prompts for Specialty Pharmacy.

1 Prescriptions may also be available for up to a 90-day supply at participating FutureScripts Act 207 retail pharmacies for the same mail order member cost. To learn more about mail order services and ACT 207 pharmacies, contact FutureScripts at the number on the back of your ID card.

2 Keystone HMO Silver Proactive Value and Keystone HMO Bronze are not available for purchase through the Federal Health Insurance Marketplace.

3 Personal Choice® Bronze Basic is only available for purchase through the Federal Health Insurance Marketplace at Healthcare.gov.