Prescription Plan
Your pharmacy benefit services are provided by BCBS of NC. You will receive one ID card for both medial and pharmacy. To access the BCBS of NC formulary call BCBS of NC Member Services at 1.800.517.8072.
| Basic | Standard | Premium | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Benefit Highlights | In-Network | Out of Network | In-Network | Out of Network | In-Network | Out of Network | ||||||||
| Prescription | ||||||||||||||
| Retail- 30 day supply | Tiers 1 & 2: $10 Tiers 3, 4 & 5: 100% to $125 |
Tiers 1 & 2: $10 Tiers 3, 4 & 5: 50% to $100, Min $50 |
Tiers 1 & 2: $10 Tier 3: $30 Tiers 4 & 5: 25% to $100, Min $50 |
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| Mail Order (McNeill's Pharmacy) - 31 to 90 day supply - only option for mail order | Tiers 1 & 2: $0 Tiers 3, 4 & 5: 100% to $125 |
Tiers 1 & 2: $0 Tiers 3, 4 & 5: 50% to $100, Min $50 |
Tiers 1 & 2: $0 Tier 3: $30 Tiers 4 & 5: 25% to $100, Min $50 |
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| Formulary | NetResults 5 tier restricted formulary | NetResults 5 tier restricted formulary | NetResults 5 tier restricted formulary | |||||||||||
| HPN In-Network Coverage Only | ||||
|---|---|---|---|---|
| Benefit Highlights | In-Network | |||
| Prescription | ||||
| Retail- 30 day supply | Tiers 1 & 2: $10 Tiers 3, 4 & 5: 100% to $125 | |||
| Mail Order (McNeill's Pharmacy) - 31 to 90 day supply - only option for mail order | Tiers 1 & 2: $0 Tiers 3, 4 & 5: 100% to $125 | |||
| Formulary | 5 tier restricted formulary | |||
Accredo Specialty Pharmacy Member Flyer
Video: Prescription Drug Benefits
