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Frequently Asked Questions

Pharmacy


Q: How do I get prescriptions filled through a mail order pharmacy? Top of Page

A:BCBSNC's prescription drug mail service is provided by PrimeMail. You can order your prescriptions online or through the mail – choose whatever works best for you.

For a new prescription, you’ll receive your medication 5-10 business days after PrimeMail receives your order. For refills, expect your medication 3-5 business days after PrimeMail receives your order.

Members, learn more about PrimeMail.

Non-members, learn more about ordering prescription drugs.

Q: What is the difference between generic and brand-name drugs and how does that difference affect my benefits? Top of Page

A: A generic drug is identical, or bioequivalent, to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Certain inactive ingredients that give the generic product its shape, color or flavor may be different than the brand product. Health professionals and consumers can be assured that FDA approved generic drugs have met the same rigid standards as the innovator drug. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price.

Depending upon your benefit design, you may substantially lower your out-of-pocket expense by using a generic drug instead of the branded drug. For example, if you have a $10 generic copay (tier 1) and $35 non-preferred brand copay (tier 3), you can save $25 on every prescription just by choosing generics. For drugs you take each month, that's a savings of $300 over an entire year. If your prescription drug benefit is based on coinsurance, generic drugs will save you money because they cost less than their branded counterparts.(In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately, please refer to your Member Guide to confirm that your pharmacy benefits are offered through BCBSNC.)

Q: Can I get reimbursed for drugs I got from a pharmacy outside of the network? Top of Page

A: Reimbursement varies according to plans. For more information, please refer to your Member Guide to find out if benefits are available for pharmacies outside of your network.

Q: If I am going to be out of town for an extended time, how do I get an extra supply of drugs to cover me through that period? Top of Page

A: If you will be going out of town for an extended time, benefits are available for an extended supply of up to 90 days for prescription drugs. However, you cannot refill a prescription until three-fourths of your current supply has been used. If you have not used three-fourths of your current supply but do not have enough medication to last through your trip, speak with your pharmacist about an early refill for up to an additional 30-day supply. If this amount is not enough, call BCBSNC Customer Service at 1-877-258-3334 for assistance. (In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately, please refer to your Member Guide to confirm that your pharmacy benefits are offered through BCBSNC.)

Q: What is a drug formulary (or preferred drug list) and how does that affect me? Top of Page

A: BCBSNC's prescription drug formulary is a list of FDA-approved prescription drugs reviewed and maintained by the BCBSNC Pharmacy and Therapeutics (P&T) Committee, comprised of independent physicians and pharmacists. BCBSNC offers an open formulary; therefore, no drugs are considered non-formulary.

If your prescription drug benefit is based on copayments, the formulary can help you determine your copayment for a specific drug. It also provides a list of possible therapeutic alternatives that may be available at a lower copayment. If your prescription drug benefit is based on coinsurance, the formulary can help you identify any available low cost generic drugs. If you would like an updated copy of the formulary, free of charge, please call BCBSNC's Customer Service at 1-877-258-3334. You should bring your copy of the formulary with you when you visit the doctor. You may also get formulary information by using the online Prescription Drug Search. (In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately. Please refer to your Member Guide to confirm that your pharmacy benefits are offered through BCBSNC.)