1The amount of medication you can obtain at a retail or home delivery pharmacy depends on your drug benefit. Please refer to your Certificate of Coverage or policy.
2Some plans may require paper claim submissions to process reimbursements. Check you Certificate of Coverage for more information.
3Not all benefits include separate cost shares for generic preferred or generic nonpreferred drugs. For benefits that have one generic cost share for generic drugs, the cost share will be applied to all generic drugs. Refer to your Certificate of Coverage for specific information about your prescription drug benefit.
4Prior authorization and Step Therapy requests are processed as soon as possible once all information/documentation is received by Capital BlueCross. For requests that meet predetermined clinical criteria, notification of approval will be communicated to the physician and to the member in writing. If prior authorization is denied, written notification, including the reason for the denial, will be sent to the member and the prescribing physician. In-network physicians and members have the right to appeal a denial. Appeal instructions are provided with the written denial notification.
5Some plans allow an initial 30-day fill and a 30-day refill for maintenance drugs before 90DayMyWay requires members to get 90-day fills. Check your Certificate of Coverage for details. Drug quantity level limits apply to all applicable generic equivalents of the brand-name products. Applicable home delivery quantity levels are two to three times the retail quantity level limits, depending on the prescription drug benefit design chosen by the member or employer group.