PSHB FEP Blue Standard and FEP Blue Basic Options
2027 Blue Cross and Blue Shield Service Benefit Plan
FEP Blue Standard and FEP Blue Basic
Section 5(f). Prescription Drug Benefits
FEP Blue Standard and FEP Blue Basic
Section 5(f). Prescription Drug Benefits
Benefits Description
Preferred Diabetic Medications, Test Strips, Lancets and Tubeless Insulin Delivery Systems
(See Section 5(a) for our coverage of insulin pumps with tubes.)
Standard Option - You Pay
Tier 2 (preferred diabetic medications and supplies): $35 copayment for each purchase of up to a 30-day supply ($70 copayment for a 31 to 90-day supply) (no deductible)
Tier 2 (preferred insulins): $35 copayment for each purchase of up to a 30-day supply ($70 copayment for a 31 to 90-day supply) (no deductible)
Basic Option - You Pay
Tier 2 (preferred diabetic medications and supplies): $35 copayment for each purchase of up to a 30-day supply ($105 copayment for a 31 to 90-day supply)
Mail Service Prescription Drug Program:
Note: See earlier in this section for Tier 2, 3, 4, and 5 prescription drug benefits.
Benefits will be provided for syringes, pens and pen needles and test strips at Tier 2 (diabetic medications and supplies) for Standard Option members through the Mail Service Prescription Drug Program.
Standard Option - You Pay
Tier 2 (preferred brand-name drug): $40 copayment for each purchase of up to a 90-day supply (no deductible)
Basic Option - You Pay
Note: Although you do not have access to the Mail Service Prescription Drug Program, you may request home delivery of prescription drugs you purchase from Preferred retail pharmacies offering options for online ordering.
Preferred Diabetic Medications, Test Strips, Lancets and Tubeless Insulin Delivery Systems
(See Section 5(a) for our coverage of insulin pumps with tubes.)
Standard Option - You Pay
Tier 2 (preferred diabetic medications and supplies): $35 copayment for each purchase of up to a 30-day supply ($70 copayment for a 31 to 90-day supply) (no deductible)
Tier 2 (preferred insulins): $35 copayment for each purchase of up to a 30-day supply ($70 copayment for a 31 to 90-day supply) (no deductible)
Basic Option - You Pay
Tier 2 (preferred diabetic medications and supplies): $35 copayment for each purchase of up to a 30-day supply ($105 copayment for a 31 to 90-day supply)
Mail Service Prescription Drug Program:
Note: See earlier in this section for Tier 2, 3, 4, and 5 prescription drug benefits.
Benefits will be provided for syringes, pens and pen needles and test strips at Tier 2 (diabetic medications and supplies) for Standard Option members through the Mail Service Prescription Drug Program.
Standard Option - You Pay
Tier 2 (preferred brand-name drug): $40 copayment for each purchase of up to a 90-day supply (no deductible)
Basic Option - You Pay
Note: Although you do not have access to the Mail Service Prescription Drug Program, you may request home delivery of prescription drugs you purchase from Preferred retail pharmacies offering options for online ordering.