Generic Drugs (Tier 1) n Copaysforgenericdrugsarethelowest. n Mostgenericdrugsareonthepreferreddruglistandavailableatthe lowestcopay. Preferred Brand Name Drugs (Tier 2) n Copaysforpreferredbrandnamedrugsarehigherthangenericdrugs. n Whenagenericversionofapreferredbrandnamedrugbecomesavailable, thebrandnameversionmovesfromTier2toTier3(non‑preferredbrand namedrugs). Non-Preferred Brand Name Drugs (Tier 3)* *Non-preferred brand name drugs are not part of the preferred drug list but are covered at the highest copay. n Copaysfornon‑preferredbrandnamedrugsarethehighest. n Ifyourbrandnamedrughasagenericequivalent,thebrandnamedrug willnotbeonthepreferreddruglistandwillbeaTier3drug. n Youwillpaythelowestcopay(Tier1)ifyouchoosethegenericversion ofadrugandthehighestcopayifyouchoosethebrandname(Tier3) versionofadrug. n SomeplansrequirememberswhochooseaTier3drugoveritsgeneric equivalent(Tier1)topaythehighestcopayPLUSthedifferenceincost betweenthebrandnamedrugandthegenericdrug.Pleaserefertoyour membercontractfordetails. Prescriptiondrugscanaccountforalargepercentageofyourhealthcarecosts. ByusingtheCareFirstBlueCrossBlueShield(CareFirst)preferreddruglist,also calledaformulary,youcandiscusswithyourphysicianandyourpharmacist abouthowtomakesafeandcost‑effectivedecisionstobettermanageyour healthcare. What is a preferred drug list? CareFirst’spreferreddruglistispartofthe3‑TierPrescriptionDrugProgramthat consistsofbothgeneric(Tier1)andpreferredbrandname(Tier2)drugsthatare selectedfortheireffectivenessandaffordability.Non‑preferredbrandname(Tier 3)drugsarenotpartofthepreferreddruglist,butarecoveredbyyourpharmacy benefitsatthehighestcopay. How do drugs get on the preferred drug list? Thepreferreddruglistisbasedoncurrentmedicalresearchandinputfroma committeeofdoctorsandpharmacistswhoservetheCareFirstregion.Drugsare selectedfortheirquality,effectivenessandcost.Thepreferreddruglistchanges frequentlyinresponsetoFoodandDrugAdministration(FDA)requirements.The listisalsoadjustedwhenagenericdrugisintroducedforabrandnamedrug.When thathappens,thegenericdrugwillbeaddedtotheTier1listandthebrandname drugwillautomaticallymovefromTier2toTier3. Preferred Drug List (Formulary) CareFirst BlueCross BlueShield
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Preferred Drug List (Formulary) - corporate · Generic Drugs (Tier 1) n Copays for generic drugs are the lowest. n Most generic drugs are on the preferred drug list and available
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Generic Drugs (Tier 1) n �Copays�for�generic�drugs�are�the�lowest.
n �Most�generic�drugs�are�on�the�preferred�drug�list�and�available�at�the�lowest�copay.
Preferred Brand Name Drugs (Tier 2)
n �Copays�for�preferred�brand�name�drugs�are�higher�than�generic�drugs.
n �When�a�generic�version�of�a�preferred�brand�name�drug�becomes�available,�the�brand�name�version�moves�from�Tier�2�to�Tier�3�(non‑preferred�brand�name�drugs).
Non-Preferred Brand Name Drugs (Tier 3)*
*Non-preferred brand name drugs are not part of the preferred drug list but are covered at the highest copay.
n �Copays�for�non‑preferred�brand�name�drugs�are�the�highest.
n �If�your�brand�name�drug�has�a�generic�equivalent,�the�brand�name�drug�will�not�be�on�the�preferred�drug�list�and�will�be�a�Tier�3�drug.
n �You�will�pay�the�lowest�copay�(Tier�1)�if�you�choose�the�generic�version�of�a�drug�and�the�highest�copay�if�you�choose�the�brand�name�(Tier�3)�version�of�a�drug.
n �Some�plans�require�members�who�choose�a�Tier�3�drug�over�its�generic�equivalent�(Tier�1)�to�pay�the�highest�copay�PLUS�the�difference�in�cost�between�the�brand�name�drug�and�the�generic�drug.�Please�refer�to�your�member�contract�for�details.
What is a preferred drug list?CareFirst’s�preferred�drug�list�is�part�of�the�3‑Tier�Prescription�Drug�Program�that�consists�of�both�generic�(Tier�1)�and�preferred�brand�name�(Tier�2)�drugs�that�are�selected�for�their�effectiveness�and�affordability.�Non‑preferred�brand�name�(Tier�3)�drugs�are�not�part�of�the�preferred�drug�list,�but�are�covered�by�your�pharmacy�benefits�at�the�highest�copay.�
How do drugs get on the preferred drug list?The�preferred�drug�list�is�based�on�current�medical�research�and�input�from�a�committee�of�doctors�and�pharmacists�who�serve�the�CareFirst�region.�Drugs�are�selected�for�their�quality,�effectiveness�and�cost.��The�preferred�drug�list�changes�frequently�in�response�to�Food�and�Drug�Administration�(FDA)�requirements.�The�list�is�also�adjusted�when�a�generic�drug�is�introduced�for�a�brand�name�drug.�When�that�happens,�the�generic�drug�will�be�added�to�the�Tier�1�list�and�the�brand�name�drug�will�automatically�move�from�Tier�2��to�Tier�3.
Preferred Drug List (Formulary)CareFirst BlueCross BlueShield
**This list represents the most frequently prescribed drugs in each category. Discuss with your physician if there are specific alternatives to your current medication on lower tiers. ● Self-Administered Injectable Drugs (Some plans may require a coinsurance payment.)
Generic Drugs (Tier 1)
Lowest Copay
Preferred Brand Name Drugs
(Tier 2) Middle Copay
Non-Preferred Brand Name Drugs
(Tier 3) Highest Copay
Generic Drugs (Tier 1)
Lowest Copay
Preferred Brand Name Drugs
(Tier 2) Middle Copay
Non-Preferred Brand Name Drugs
(Tier 3) Highest Copay
Preferred Drug List (Formulary)CareFirst BlueCross BlueShield
CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.
BRC5943‑4P�(11/10)
Using Generic DrugsDid�you�know�that�switching�to�a�generic�drug�could�save�you�money�in�out‑of‑pocket�prescription�costs?�Generic�drugs�are�made�with�the�same�active�ingredients�as�brand‑name�drugs�and�have�the�same�effects�in�the�body.�The�difference?�Name�and�price.