You have chosen one of the prescription drug plans below for your employees. Please refer to your Prescription Drug Plan Rider or BCBSNM member ID card to confirm which plan you selected.
4-Tier Drug Plan
The 4-Tier prescription drug plan allows members to get a prescription drug even if it's not on the BCBSNM Drug List and to get a brand-name drug even when a generic-equivalent is available. The copay is based on whether the member is receiving a generic drug or a brand-name drug AND whether the drug is on our Drug List.
Prescription drug payments are based on the following tier structure for a 30-day supply or 120 units, whichever is less.
Tier 1 copay: The member pays this amount for a generic drug.
Tier 2 copay*: The member pays this amount for a brand-name drug that is on our drug list when no generic is available.
Tier 3 copay*: The member pays this amount for a brand-name drug that is not on our drug list or when receiving a preferred specialty drug**.
Tier 4 copay for non-preferred specialty drugs**: The member pays 15% of covered charges or up to a $250 maximum copay per prescription for non-preferred specialty drugs.
Advise your employees to have prescriptions filled at either a participating pharmacy or through the PrimeMail Pharmacy Program. Search the Provider Finder to locate a participating pharmacy in New Mexico. Coverage is always subject to the limitations of your group's health care plan. For some medications, prior approval requirements, generic substitution, or quantity limits may apply.
See your Prescription Drug Plan Rider for details, limitations, exclusions, and Specialty Pharmacy Program information.
* If a member or a member's doctor prefers that he or she receive a brand-name drug when a generic equivalent is available, the member will pay the Tier 1 copay PLUS the difference in cost between the generic and brand-name drug.
** Specialty pharmacy drugs are used to treat serious and/or chronic conditions such as multiple sclerosis, pulmonary hypertension, hepatitis, and rheumatoid arthritis. These medications are typically injectable and can be administered by a patient or family member. Members must use a contracting specialty network pharmacy to fill these specific prescriptions.
Under the PrimeMail Pharmacy Program, you can select a plan that allows your employees to receive up to three packages (a 90-day supply) via mail order for only 2-1/2 times the retail copay.