Pharmacy Benefits for Large Employers

Pharmacy benefits plans for large employers have 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, which are divided into four copayment tiers.

4 Tier

  • Tier 1: Low-cost generic drugs
  • Tier 2: Higher cost generic and preferred brand name drugs
  • Tier 3: Highest cost generic and non-preferred brand name drugs
  • Tier 4: Specialty drugs
BCBSRI 4 Tier Formulary Drug List PDF
4 Tier 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.

 

5 Tier

  • Tier 1: Low-cost generic drugs
  • Tier 2: Higher cost generic and preferred brand name drugs
  • Tier 3: Highest cost generic and non-preferred brand name drugs
  • Tier 4: Preferred specialty drugs
  • Tier 5: Non-preferred specialty drugs
BCBSRI 5 Tier Formulary Drug List PDF
5 Tier 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.

 

6 Tier

  • Tier 1: Lowest cost generic drugs
  • Tier 2: Low-cost generic drugs
  • Tier 3: Higher cost generic and preferred brand name drugs
  • Tier 4: Highest cost generic and non-preferred brand name drugs
  • Tier 5: Preferred specialty drugs
  • Tier 6: Non-preferred specialty drugs
BCBSRI 6 Tier Formulary Drug List PDF
6 Tier 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.

 

Networks

Standard Pharmacy Network
The BCBSRI pharmacy network comprises more than 67,000 in-network retail pharmacies nationwide, including CVS, Walgreens, and Rite Aid, as well as Walmart, supermarket, and independent pharmacies.

Advance Pharmacy Network
BCBSRI now offers an additional network option, Advance Pharmacy Network. This lower-cost network includes national and regional pharmacies at CVS, Walmart, and supermarkets, as well as independent pharmacies. It does not include Walgreens or Rite Aid.


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 AllianceRx Walgreens Prime, our mail order service. 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.

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) 
Rx90 (Maintenance) Drug List
BCBSRI HSA Preventive Drug List