Blue Cross Prescription

SamIam

Guru
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Am I correct that you need to meet your deductible for bcbs on RX unless it's tier 1 generic. So precision silver if it's a tier 2 once you meet your deductible then the client pays 20% co-insurance. Thats what BCBS customer service told me last year but they looked it up. I spoke to fellow broker they told me that is incorrect. You don't need to meet your deductible you pay the co-insurance right away.
 
Am I correct that you need to meet your deductible for bcbs on RX unless it's tier 1 generic.

Technically it is correct. That's how it is written in the summary of benefits, and this how I explain this to clients. In the reality it can go both ways. I have a few clients that told me their meds were covered before deductible, even though they are tier 2,3,4 or 5. But others said that, yes they have to pay their deductible first, and then medications are covered. It is both HMOs, Blue Precision and BlueCare Direct.
 
Am I correct that you need to meet your deductible for bcbs on RX unless it's tier 1 generic. So precision silver if it's a tier 2 once you meet your deductible then the client pays 20% co-insurance. Thats what BCBS customer service told me last year but they looked it up. I spoke to fellow broker they told me that is incorrect. You don't need to meet your deductible you pay the co-insurance right away.

Since companies are continuing to "water down" their prescription benefits, it appears that for 2017 Silver plans, the Deductible must be met before Prescription Benefits are paid.

That's what Annotation #6 at the bottom of this BCBS-IL Silver comparison chart says.
Silver Comparison Chart: https://www.bcbsil.com/static/il/pdf/compare-plans/2017/silver-plans.pdf

This BCBS-IL prescription setup is the worst I've ever seen from them.
 
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