Members (19 years of age and older) must pay a portion of the cost of covered
drugs that may be obtained at the retail and mail order pharmacies. This
out-of-pocket copayment is collected at the pharmacy at the time the
prescriptions are filled. Certain members may be exempt from paying a
copayment, click here
to see the exemption copayment rules. The copayment amount is based on each
prescription filled.
* Copayments for
covered generic and over-the-counter drugs (with a prescription) will be
$3 EXCEPT for certain covered generic drugs that members may
take for high blood pressure, high cholesterol or diabetes. The copayment
for these will be $1.
The BMC HealthNet Plan Formulary allows members and providers
to search for a specific drug and confirm its tier assignment. Users are
reminded to choose the member’s correct plan type before looking up a drug in
order to obtain accurate tier information. After determining which tier a
covered drug belongs to, the user may look up the tier and member plan type in
the chart above to determine the actual out-of-pocket copayment.
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