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Health Insurance Information 

Prescription Drug Program

The features of your prescription drug program:

Wellmark BC/BS

Blue Access, Blue Advantage

Your prescription drug benefits are provided through a three-tier program. This means that you pay a copayment at the time you receive your prescription.   The amount of your copayment is determined by the drug that you receive.

Copayment amounts are:

If you purchase a brand name drug when an FDA-approved “A”-rated generic equivalent is available, you are responsible for your co-payment or coinsurance, plus any difference between the billed charge for the brand name drug and the billed charge for the generic. This can result in you paying substantially higher costs than if you had chosen the generic drug.

State III Plus and Iowa Select

Your prescription drug benefits are provided through a three-tier program. This means that you pay a copayment at the time you receive your prescription. The amount of your copayment is determined by the drug that you receive.

Copayment amounts are:

If you purchase a brand name drug when an FDA-approved “A”-rated generic equivalent is available, you are responsible for your co-payment or coinsurance, plus any difference between the billed charge for the brand name drug and the billed charge for the generic. This can result in you paying substantially higher costs than if you had chosen the generic drug.

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Participating Pharmacies

At participating pharmacies, simply present your prescription drug ID card to the pharmacist. Your eligibility for benefits will be confirmed via a computerized system. The pharmacist will tell you the amount that you are responsible for paying. You do not have to file a claim form for prescriptions filled at a participating pharmacy.

To find a participating pharmacy nearest to you, call your toll-free member services number on the back of your ID card and use the voice activated pharmacy locator system or visit the pharmacy locator on-line at www.wellmark.com.

If you use a non-participating pharmacy, you must submit a completed claim form to Catamaran Rx. The prescription receipt must be attached to the form. To obtain claim forms, call member services. You are responsible for 100% of the price of the prescription at the time of purchase. You will be reimbursed within twenty-one days of your claim form being received. Reimbursement will be in the amount that you would have paid to a participating pharmacy, less your copayment.

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Analysis and Reporting

Prescription information is used by Catamaran Rx and affiliates to administer your health benefit drug programs. Catamaran Rx also uses the information and prescription data gathered from claims submitted nationwide for reporting and analysis without identifying individual patients.

Prior Approval

A special feature of your prescription drug plan is prior approval. Payment of a drug that is not normally covered by your plan can be requested by getting prior approval and if it is part of a specific treatment plan and medically necessary. Your practitioner should request prior approval by providing the reason the drug should be covered and the length of time. If your medication is not approved for coverage under your plan, you will be responsible for paying the full cost of the drug.

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Preferred Prescription Formulary

Your prescription drug program includes a voluntary-formulary feature. A formulary is a list of commonly prescribed medications that have been selected based upon their clinical effectiveness and opportunities for savings. By asking your doctor to prescribe formulary medications, you can help control rising health care costs while maintaining high quality care. Use of a formulary drug is voluntary. There is no financial penalty if your physician does not prescribe a formulary drug.

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Generic Drugs

The brand-name is the name under which a product is advertised and sold. Generic-equivalent medications contain the same active ingredients and are subject to the same rigid FDA standards for quality, strength, and purity as their brand-name counterparts. Generally generic drugs cost less than a brand-name drug. You should ask your doctor to prescribe generic drugs whenever appropriate.

If you select a brand-name drug when there is a generic-equivalent available, you will be responsible for the difference between the brand-name cost and generic drug cost.

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Education

Wellmark offers the tools you may need to manage and improve your health through the internet. They can be reached a www.wellmark.com. Browse through the brochures, safety tips, answers to most common medication questions, or just keep up with timely health issues.

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Drug Utilization Review

Under this program, when your prescriptions are filled through participating retail pharmacies, they are reviewed for any potential drug interactions based upon your personal medication profile. This is especially important if you take many different medications or see more than one physician. If there is a question about your prescription, your pharmacist may contact your physician before dispensing the medication.

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Frequently Asked Questions

What are the benefits of using an Catamaran Rx prescription network pharmacy?

You have lower out-of-pocket costs due to negotiated discounts. No claim forms. Prescriptions reviewed at time of dispensing for potential drug interactions. Your pharmacist can immediately advise you of plan coverage and any prior approval requirements.

How do I find a participating pharmacy?

Call your member services toll-free number to access the voice-activated 24-hour pharmacy locator system. You will need to enter your member number and the zip code of the area in which you wish to find a pharmacy. The voice-activated system responds with the name and addresses of pharmacies within that area or check www.wellmark.com. Look in the members section for general pharmacy information.

How do I know if my drug is covered under the program?

When you use a participating pharmacy, a computerized system processes your order. This system will alert the pharmacist if the medication prescribed is not covered.

What’s the benefit of using the formulary?

The formulary is a list of commonly prescribed drugs. It’s voluntary use may lower the costs of your prescribed mediations.

What if I have a question about my medication?

If you have a question, please ask your pharmacist or physician.

Are there differences between brand name and generic drugs?

The brand-name of a drug is the name under which a drug is advertised and sold. Generic-equivalent medication contain the same active ingredients and are subject to the same rigid FDA standards for quality, strength, and purity as their brand-name counterparts. Generic drugs are less expensive than brand-name drugs.

What happens if I need to purchase a prescription but do not have my ID card with me?

Your participating pharmacy can simply look you up on their computer system by name and social security number. They can still submit electronically for you. If your pharmacy does not participate in the Catamaran Rx network, you must submit a claim form. Please note that you may have to supply some form of identification (such as a driver’s license) to the pharmacist to verify information.

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