Pharmacy Benefits

Pharmacist scanning drug box
All of our health plans include comprehensive prescription drug coverage designed to reduce your out-of-pocket costs. No matter which health plan you choose, you'll have access to a wide range of medications and an extensive pharmacy network.

The BCBSRI Formulary (drug list) is divided into five tiers. Each tier has a corresponding copayment, depending on the health plan. The descriptions below show what types of drugs are covered under each tier. 

The Five Tiers

  • 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 Catamaran Home Delivery. 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 contain 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.