Blue Cross Blue Shield Vermont: Three Tier Program

Three-tier Prescription Drug Program

To purchase drugs, present your Blue Cross and Blue Shield of Vermont I.D. card at a network pharmacy. (You will not receive a separate card for drug purchases).

You must meet a $100 prescription drug deductible per member, per year that is separate from your other deductibles. Then you pay coinsurance for each prescription (up to a 30-day supply).

You pay:


•	a 40% coinsurance for generic drugs,
•	a 50% coinsurance for brand-name drugs that are on our Preferred Brand-name Drug List, or
•	a 60% coinsurance for brand-name drugs that are not on our Preferred Brand-name Drug List (Non-Preferred drugs).

After a member pays $5,000 in deductible and coinsurance for drugs in a calendar year, we pay the full cost of that member's covered drugs for the rest of the year.

The Preferred Brand-name Drug List can change and will be updated from time to time to ensure that newer, more effective drugs are on it. The latest copy of the list is here.

The pharmacy will charge you for any deductible or coinsurance you owe when you buy your drug, and will then bill BCBSVT for the rest. You do not need to fill out complicated paperwork.

You must use RESTAT network pharmacies to get benefits from your prescription drug coverage. Most pharmacies in Vermont, and 97% of pharmacies nationwide, are in this network. The network includes major chains (Rite-Aid, Brooks, CVS, etc.).

How the Mail Order Program Works

Send your doctor's prescription, an order form and your coinsurance payment to our mail order pharmacy. If you are using the mail order service for the first time, you must also send a confidential patient profile and an enrollment form. To get an order form for the mail order program, call BCBSVT’s customer service department at (800) 247-2583 to get an application and an envelope.
Please note that the mail order program is voluntary. But for most people, it will offer greater convenience and cost savings.

When You Need a Refill

You may use the web-based ordering system (www.ipsrx.com) or call a toll-free number to request refills through the mail order program.

Note: This is only a summary of benefits. Please refer to your Vermont Freedom Plan Certificate of Coverage for specifics about your coverage.