CareFirst BlueCross BlueShield Medicare Advantage provides comprehensive prescription drug coverage with NO annual deductible.
Resource information for our CareFirst BlueCross BlueShield Advantage DualPrime plan can be found here.
Find out if your prescription is covered.
| CareFirst BlueCross BlueShield Advantage Core (HMO) |
CareFirst BlueCross BlueShield Advantage Enhanced (HMO) | |||||
|---|---|---|---|---|---|---|
| Copay for One-Month Supply | Copay for Two-Month Supply | Copay for Three-Month Supply* | Copay for One-Month Supply | Copay for Two-Month Supply | Copay for Three-Month Supply* | |
| Tier 1 - Preferred Generic | $4.00 | $4.00 | $4.00 | $2.00 | $2.00 | $2.00 |
| Tier 2 - Generic | $20.00 | $20.00 | $20.00 | $15.00 | $15.00 | $15.00 |
| Tier 3 - Preferred Brand | $47.00 | $94.00 | $94.00 mail $141.00 retail |
$47.00 | $94.00 | $94.00 mail $141.00 retail |
| Tier 4 - Non-Preferred Drug |
40% of the total cost | 40% of the total cost | 40% of the total cost | 40% of the total cost | 40% of the total cost | 40% of the total cost |
| Tier 5 - Specialty | 33% of the total cost | Not Available | Not Available | 33% of the total cost | Not Available | Not Available |
* As of January 1, 2024, members are eligible to receive 100-day supplies of their tier 1 and tier 2 medications for the same copay as a 30-day supply. Additionally, members are eligible to receive 100-day supplies of their tier 3 medications for the same copay as a 90-day supply.
You won’t pay more than $35 for a one-month supply, $70 for up to a two-month supply or $105 for up to a three-month supply of each covered insulin product regardless of the cost-sharing tier.
For more on prescription drug costs, including prescription limitations and prior authorization requirements, see Chapters 5 and 6 of the Evidence of Coverage - Core or Evidence of Coverage - Enhanced.
Our Pharmacy NetworkYou’ll have access to over 66,000 pharmacies nationwide.
Most major pharmacy chains and many independent pharmacies are part of our network, including CVS, Walmart, Sam’s Club, Walgreens, Rite Aid, Sav-On Pharmacy, Safeway, Medicine Shoppe, Publix, Albertson’s, Costco, Kroger, Harris Teeter, Giant and Giant Eagle.
Most residents of our service area live within two miles of a participating pharmacy, making refills even more convenient.
Sign Up for Mail Order Prescriptions and SaveSave money and time by refilling prescriptions online, by phone or through email with CVS Caremark Mail Service Pharmacy. Choose your delivery location and consult with pharmacists by phone 24/7. Sign up for a 90-day supply by mail, and you’ll only pay the cost of a 60-day supply for certain tiers. (Tier 5- Specialty drugs are not eligible for 60-day and 90-day supplies via mail order. Please refer to the Evidence of Coverage - Core or Evidence of Coverage - Enhanced for more information.)
Mail Order Pharmacy Enrollment Form (PDF) This link opens in a new window.
The donut hole, or coverage gap, starts when your total drug costs—including what you and your plan have paid for drugs—reaches $5,030 for the calendar year. When you enter the donut hole, the amount you pay for your prescriptions will increase. Because of this, you are eligible for discounts to help you pay for your drugs. You will pay 25% for generics drugs and 25% for brand name drugs, plus a portion of the dispensing fee. Discounts vary depending on the drug and your plan’s Formulary
The CareFirst BlueCross BlueShield Advantage Enhanced plan includes gap coverage for Tier 1 drugs (preferred generic) at the same mail, retail, out-of-network (OON) and long-term care (LTC) cost-sharing as shown below. For more information please refer to your Evidence of Coverage - Core or Evidence of Coverage - Enhanced.
| Tier 1 (Preferred Generic) |
Retail | Mail Order | Out-of-Network | Long Term Care |
|---|---|---|---|---|
| One Month | $2.00 | $2.00 | $2.00 | $2.00 |
| Two Months | $2.00 | $2.00 | Not Covered | Not Covered |
| Three Months | $2.00 | $2.00 | Not Covered | Not Covered |
| 100-Day Supply | $2.00 | $2.00 | Not Covered | Not Covered |
