Prescription Drugs

How the Plan Works

You can get your prescriptions filled and refilled through a Blue Cross & Blue Shield network pharmacy, including most major pharmacy chains and certain local independent pharmacies. You can also use the mail-order program to get up to a 90-day supply of your medication and save money.

Blue Cross & Blue Shield of Rhode Island administers the prescription drug plan, but the money to pay claims comes from you and your contributing employer. Learn about who really pays benefits when you have an Rx claim.

Maintenance drugs

Maintenance drugs are taken regularly for long-term or chronic health conditions such as diabetes, high blood pressure, or heart issues. A network pharmacy provides your maintenance drug prescription at the greater of a 30-day supply or 100 pills, saving you money.

Supplemental drug program, if you lose coverage

If you lose Health Fund coverage because no work is available, you and your covered family members can get generic maintenance drugs for diabetes, high cholesterol, hypertension, and asthma by mail at 20% of the cost per prescription. For details, contact the Fund Office: 401-942-8690.

What You Pay

Network pharmacy: 20%, with a maximum payment of $100 for up to a 30-day supply. For insulin drugs, the maximum payment is only $40 for up to a 30-day supply.

Mail order: 20%, with a maximum payment of $250 for up to a 90-day supply.

Order your medication and receive it at home, usually within 48 hours. You can order refills 24/7 by calling Blue Cross & Blue Shield Customer Service: 401-459-5000 or 800-639-2227.

For specialty medications

You pay 20% of the cost, with a maximum payment of $100 if purchased at a specialty pharmacy.
You pay 50% of the cost if purchased at a retail pharmacy.
Specialty drugs are limited to a 30-day supply.

You pay 20% of the cost (no maximum) for infertility drugs whether you purchase them at a specialty or retail pharmacy.

Who really pays benefits when you have an Rx claim?

Our medical and prescription drug (Rx) plans are self-funded. This means the Fund uses an insurance company—Blue Cross & Blue Shield of Rhode Island—to give you access to lower-cost, in-network doctors, hospitals, and pharmacies. Blue Cross also administers our medical and Rx benefits claims.

The money to pay claims does not come from Blue Cross & Blue Shield of Rhode Island. It comes from the income generated by contributions (made on your behalf) from participating employers to the Fund. This means the Health Fund takes on all the financial responsibility of providing your medical and Rx coverage and paying benefits:

Each year, medical and Rx benefit payments for members could be lower than expected. If so, the Health Fund saves money. The savings stay in the Fund, making the Fund stronger financially.
However, each year, benefit payments for members could be higher than expected. If so, the Health Fund pays money from its financial reserves to cover the higher costs.

Bottom Line

The Trustees believe that being a well-managed, self-funded health plan is a financially advantageous arrangement for the Fund. You can help ensure a financially strong Health Fund by using your medical and Rx coverage in ways that save you and the Fund money. For example, by seeing in-network doctors and using mail order for prescription drugs. A financially strong Fund can continue into the future providing the high-quality, comprehensive health coverage you’ve earned and come to expect.

Questions?

For questions about the pharmacy network or to order through the mail-order program, call BCBS of Rhode Island or visit their website and log in to find a network pharmacy.

BCBS of Rhode Island
401-459-5000 or 800-639-2227
bcbsri.com