Pharmacy Benefits for Small Employers

Pharmacy benefits plans for small employers have either four or five tiers of copayments. Plans also include features to help address the rising cost of healthcare.

With BCBSRI you can count on comprehensive prescription drug coverage that includes features to help address the rising cost of healthcare. Our formulary (drug list) gives you access to a wide range of medications, and which are divided into four tier and five tier options.

5 Tier

  • First Tier: Includes generic prescription drugs that have the lowest copayment.
  • Second Tier: Includes higher cost generic prescription drugs. 
  • Third Tier: Includes higher cost generic prescription drugs and preferred brand name prescription drugs.
  • Fourth Tier: Includes the highest cost generic drugs and non-preferred brand name drugs. 
  • Fifth Tier: Includes specialty prescription drugs that have the highest copayment.

BCBSRI 5 Tier Formulary Drug List PDF


Additional Prescription Drug Benefits
You can also take advantage of:

  • Easy access: Choose from a wide range of network pharmacies when getting your prescriptions filled.
  • Savings: Lower your out-of-pocket costs by using PrimeMail. Members receive a 90-day supply of medicine for 2.5 copayments. You’ll also save a trip to the pharmacy.
  • Convenience: Get your specialty pharmacy medications through Walgreens Specialty Pharmacy. They’ll be delivered to your specific location.

Providers will need to submit a Prior Authorization of Benefits Form to request prior authorization for drugs for which it is required. The Prior Authorization of Benefits Guidelines explain criteria for prior authorization. Find the forms and guidelines.

Quantity Limits
The Quantity Limit Lists contains drugs that can only be filled to a set quantity at one time. There is one for each formulary.

Pharmacy Claims
If members pay for a prescription out of pocket, they can submit a Prescription Drug Claim Form for reimbursement according to their plan.

Value Based Benefit (VBB) Incented Copay Drug List (Diabetes related and Respiratory Products)