Prescription Drugs

You should always check with your pharmacy to see if it is part of our network before you have your prescriptions filled.

With more than 55,000 network pharmacies to choose from, it's easy to find one that's near you! This network offers access to a wide variety of pharmacy options, including all CVS pharmacy®, Walmart®, Kroger® and Safeway locations, plus many grocers and independent pharmacies. Find a participating pharmacy near you by using our pharmacy locator.

Note:

Filling prescriptions at a pharmacy that is not in the Blue Option pharmacy network will require you to pay full price.

Please also note this network excludes Walgreens.

Effective immediately, you get your seasonal flu vaccine covered at $0 copay through your pharmacy benefit by visiting any network pharmacy. Find a participating pharmacy with our pharmacy locator, or you can visit your primary care physician. Don't have one? Visit the Find Care page. 

You can also visit a participating pharmacy within South Carolina or the entire U.S. to get some non-seasonal preventive care vaccines at a $0 copay. Below is a chart of these vaccines:

*FDA expanded approval; Gardasil now available for use in individuals aged 9 through 45 years. ^FDA approved in June 2024, Capvaxive is indicated for active immunization in adults aged ≥ 18. 
¥Abrysvo is the only RSV vaccine approved for use during pregnancy; dose should be received between 32 and 36 weeks. 
# As of July 2024, the age indication for Arexvy expanded to ≥ 50 years for individuals at increased risk of severe RSV outcomes. 
Ϯ Mresvia is indicated for adults aged ≥ 60 to protect against RSV. 
≠Jynneos is for prevention in individuals aged ≥ 18 who are determined to be at high risk for smallpox or monkeypox infection.

Tier 0: These drugs are considered preventive medications under the Affordable Care Act (ACA) and we cover them at no cost to you.

Tier 1: Drugs on this tier are usually generic drugs. They will typically cost the least amount of money out of your pocket.

Tier 2: Drugs on this tier are usually preferred brand-name drugs. They will typically cost less than nonpreferred brand-name drugs.

Tier 3: Drugs on this tier are usually nonpreferred brand-name drugs.

Tier 4: Drugs on this tier are usually generic specialty drugs. They typically cost more than other brand-name drugs and may have generic equivalents.

Tier 5: Drugs on this tier are usually preferred brand-name specialty drugs that are used to treat complex conditions. They are typically very expensive.

Tier 6: Drugs on this tier are usually nonpreferred brand-name specialty drugs that are used to treat complex conditions. They are typically the most expensive drugs available.

Note: Specialty medications are not available through the mail-order program for a 90-day supply. This only applies to generic or brand drugs in these tiers.

Drug management programs are quality programs that promote the safe use of medications. Prior authorization requires your doctor to get prior approval for some medications.

Quantity and dose management limit the amounts of some medications that we cover each month. Step therapy asks you to try alternative medications before we provide benefits for some medications.

Our medication adherence program helps you stay on track with taking your medications and reducing the likelihood or severity of complications, disease progression and emergency room or hospital visits. If you don’t pick up your prescriptions timely, we may reach out to you from one of these phone numbers:

• 843-883-2245
• 843-883-2246

You will take your prescription to a network pharmacy and give it to the pharmacist, along with your member ID card. The pharmacist will use a computer to check your benefits and determine the amount you pay for prescriptions.

The computer will also alert your pharmacist if there are any special requirements that apply to your prescription, such as a drug management program.

If you don’t present your ID card or you don’t use a network pharmacy, you’ll have to file a claim for your purchase and you may not be reimbursed for the full amount you paid.

You can also use our pharmacy locator to find a pharmacy.

When you use a participating pharmacy, the amount you pay depends on the specific plan you have and your medication.

Depending upon your plan, you may have a copayment (a set dollar amount) for each prescription or you may pay a percentage of the cost for each prescription (coinsurance). Some of our plans may require that you pay a deductible (an amount you pay before your insurance starts to pay) before any coinsurance percentage is applied.

Under Health Care Reform, the Affordable Care Act (ACA) requires most plans to cover certain drugs at $0 cost to members. See your schedule of benefits for more information.

You can also use our drug cost tool to look up the price of a drug.

A generic drug is a drug that’s identical to its brand name counterpart in dosage, safety, strength, quality, the way it’s used and the condition it’s used to treat.

Generics become available when patents expire on brand-name drugs. The color and shape of a generic drug may be different from its brand-name counterpart, but the Federal Drug Administration (FDA) requires that their active ingredients be the same.

To learn more about generic drugs, talk to your doctor or pharmacist.

Absolutely! The Food and Drug Administration (FDA) approves all generics and holds them to the same high safety standards as brand-name drugs. Best of all, generic drugs will usually cost you less than brand name drugs.

Most likely. There are generics available to treat many conditions, and many commonly prescribed drugs have generic versions. In fact, nearly eight out of every 10 prescriptions are now filled with generic drugs.

Specialty drugs treat conditions like cancer, hepatitis, multiple sclerosis or rheumatoid arthritis, to name a few. You will have a higher copayment for specialty drugs.

Specialty drugs that you take by mouth or self-inject will have to be filled by our preferred specialty pharmacy for you to have payment under your plan. Also, some specialty drugs require prior authorization. Your specialty prescriptions will be delivered directly to your home.

Your time is valuable. With our mail-service prescription drug program, you can get your prescriptions delivered by mail directly to your home in plain, tamper-evident packaging. When you order by mail, you can get up to a 90-day supply of medication for one low copayment — with no claim forms to file and no waiting for reimbursement! And you'll receive the medication, in the right amount, at the right cost and the right time.

Getting started

Get a written prescription from your doctor for up to a three-month supply of your medication, with three refills, if appropriate. If you are presently taking medication, ask your doctor for a new prescription.

Print and complete the mail service order form. Mail the completed form, your original prescription(s) and copayment(s) to the address listed at the bottom of the form. You can pay by check, money order, MasterCard®, Visa®, Discover or American Express®.

Our mail service will process your order and send your medication to you via U.S. mail or Federal Express, along with instructions for future refills, if you have any. Please allow up to 14 days for delivery from the time you mail your order.