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The prescription drug program provides two convenient ways to get your covered prescriptions filled, either through a retail pharmacy or by mail order. The chart below provides highlights of the prescription drug coverage for the Trooper Chapter, Airport Police and Fire Officers Chapter, Fairbanks Police Department, Fairbanks Fire Department and Juneau Police Department members, as of July 1, 2007. Refer to your Benefit Booklet for details, limitations and exclusions.
|
Service |
Retail Pharmacy Benefits |
|
Supply |
Up to a 34- or 90-day supply per prescription or refill |
|
Coverage |
100%, after your copayment |
|
Participating pharmacy |
Show your coverage identification card and pay the required copayment |
|
Nonparticipating pharmacy |
You pay the full cost for prescriptions or refills. You will be reimbursed for the cost of the prescription that a participating pharmacy would have charged, less your copayment |
|
Submitting a claim |
If you show your coverage identification card, you will not have to submit a claim, the pharmacy will bill to the plan directly. If you don’t show your card, you will have to submit a claim. Contact Premera Blue Cross Blue Shield to get a prescription drug claim form and send your claim and receipt to the address shown on the form. |
|
Contact information |
Pharmacy Benefit Customer Service: 1-800-626-6080
www.medco.com |
|
Mail Order Service |
|
Supply |
Up to a 90-day supply per prescription or refill |
|
Coverage |
100%, after your copayment; use this service for prescription drugs you take on a regular basis |
|
Contact information |
Pharmacy Benefit Customer Service: 1-800-626-6080
www.medco.com |
|
Prescription Type |
Retail Pharmacy Drug Benefit copayment
(34-day supply) |
Delivery by Mail copayment
(Up to a 90-day supply) |
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Generic
Drugs for which the manufacturer’s patent has expired. These are interchangeable with brand name drugs for all approved uses |
$10 |
$20 |
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Brand name*
Drugs that are on the Preferred Drug List – the list of brand name drugs available to the plan at discounted prices |
$30 |
$60 |
* If you request a brand name drug over a generic equivalent you will be required to pay the difference in cost between the brand name drug and the generic equivalent in addition to your copayment.
Contact Information
Premera Blue Cross Blue Shield of Alaska
P.O. Box 91059
Seattle, WA 98111-9159
Local and toll free: 1-800-508-4722
Hearing-impaired TTY:1-800-842-5357
Premera Blue Cross Blue Shield of Alaska: https://www.premera.com
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