What you need to know
With this plan, there is no deductible for prescription drugs. Cost sharing begins immediately and applies until you meet the separate prescription drug out-of-pocket limit for this plan.
Filling Your Prescriptions
You can get short-term prescriptions (30 days or less) at a network pharmacy; to get medications you take regularly, you must use home delivery from Express Scripts® Pharmacy or a participating Smart90 Anywhere Retail Pharmacy, or Kaiser mail order if you’re a Kaiser participant.
Find a pharmacy:
- BCBSNM and UnitedHealthcare participants, click here (registration and log in to Express Scripts is required)
- Kaiser participants, click here (click on search doctors, then select pharmacies)
What You Pay
| Prescription Drug Out-of-Pocket Limit* | A separate out-of-pocket limit applies $1,500 per individual, up to $5,950 combined for all family members |
| Retail Pharmacy (up to 30-day supply) or Accredo specialty mail order (up to 30-day supply) |
|
|---|---|
| Generic / specialty generic | $0 for many preventive medications Other generic medications: 20% ($5 min / $10 max) |
| Preferred brand / specialty preferred brand | 30% ($30 min / $45 max) |
| Non-preferred brand name / specialty non-preferred brand | 40% ($50 min / $75 max) |
| Express Scripts Mail Order or Express Scripts Smart90 Anywhere (90-day supply), Kaiser Mail Order (100-day supply) | |
| Generic | $0 for many preventive medications Other generic medications: 20% ($12.50 min / $25 max) |
| Preferred brand | 30% ($75 min / $112.50 max) |
| Non-preferred brand name | 40% ($125 min / $187.50 max) |
* The cost of out-of-network prescription drugs purchased outside of the program is covered at 50% and does not apply toward the out-of-pocket limit.
**Maintenance medications purchased outside of the Smart90 Anywhere participating pharmacy will be billed at the full cost after the first two months of refills. Remember to submit a 90-day script or request the 90-days from the pharmacy (if available). See Benefit Summaries for details.
Contacts and Resources
Go to the Get to Know Our Benefit Providers page for details.
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