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
Opioid rescue agents are covered under this Plan with no cost-sharing when obtained with a prescription from a pharmacy in any over-the-counter or prescription form available such as nasal sprays and intramuscular injections
Preferred Retail Pharmacies
For more information, consult the FDA guidance at https://www.fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-during-opioid-overdose or call SAMHSA's National Helpline 800-662-HELP (4357) or go to https://www.findtreatment.samhsa.gov/.
Note: Once you have purchased amounts of these medications in a calendar year that are equivalent to a 90-day supply combined, all Tier 1 fills thereafter are subject to the corresponding cost-share.
Standard Option - You Pay
Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year (no deductible)
Note: Once you have purchased amounts of these medications in a calendar year that are equivalent to a 90-day supply combined, all Tier 1 fills thereafter are subject to the corresponding cost-share.
Basic Option - You Pay
Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year
Note: Once you have purchased amounts of these medications in a calendar year that are equivalent to a 90-day supply combined, all Tier 1 fills thereafter are subject to the corresponding cost-share.
Non-preferred Retail Pharmacies
Standard Option - You Pay
You pay all charges
Basic Option - You Pay
You pay all charges
Mail Service Prescription Drug Program
Standard Option - You Pay
Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year (no deductible)
Basic Option - When Medicare Part B is primary and you are enrolled in the Medicare Prescription Drug Program, you pay the following:
Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year
Opioid rescue agents are covered under this Plan with no cost-sharing when obtained with a prescription from a pharmacy in any over-the-counter or prescription form available such as nasal sprays and intramuscular injections
Preferred Retail Pharmacies
For more information, consult the FDA guidance at https://www.fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-during-opioid-overdose or call SAMHSA's National Helpline 800-662-HELP (4357) or go to https://www.findtreatment.samhsa.gov/.
Note: Once you have purchased amounts of these medications in a calendar year that are equivalent to a 90-day supply combined, all Tier 1 fills thereafter are subject to the corresponding cost-share.
Standard Option - You Pay
Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year (no deductible)
Note: Once you have purchased amounts of these medications in a calendar year that are equivalent to a 90-day supply combined, all Tier 1 fills thereafter are subject to the corresponding cost-share.
Basic Option - You Pay
Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year
Note: Once you have purchased amounts of these medications in a calendar year that are equivalent to a 90-day supply combined, all Tier 1 fills thereafter are subject to the corresponding cost-share.
Non-preferred Retail Pharmacies
Standard Option - You Pay
You pay all charges
Basic Option - You Pay
You pay all charges
Mail Service Prescription Drug Program
Standard Option - You Pay
Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year (no deductible)
Basic Option - When Medicare Part B is primary and you are enrolled in the Medicare Prescription Drug Program, you pay the following:
Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year