888-765-5400DRUG TIER RATING
Getting prescription medications is simple. The following is a brief overview of a standard pharmacy benefits plan.
. Visit a participating pharmacy with your prescription and your BCBSNC ID card.
. A copayment or coinsurance amount is required for a prescription, unless the copayment or coinsurance is waived. Copayments are the amounts paid for each prescription. Copayments or coinsurance are determined by the tier classification for a medication.
. Claims are filed electronically. No paperwork is required.
COPAYMENT OR COINSURANCE TIERS
TIER 1 (Generic Drugs) – FDA-approved versions of brand-name medications. Features are the lowest copayments.
TIER 2 (Preferred Brand Drugs) – Brand-Name drugs that meet the needs of most patients. Second lowest copayment.
TIER 3 (Non-Preferred Brand Drugs) – Brand-name drugs without a generic version, but have therapeutic alternatives in Tier 2. Not used typically as a first line of treatment. Some brand-name drugs with a generic equivalent. Higher copayment.
TIER4 (Specialty Drugs) – Medications classified by BCBSNC as those which require special dosing or administering, are typically prescribed by a specialist and are more expensive than most medications. Usually these are the highest copayment or coinsurance amount.
For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.