Prescription drug benefits

Review your prescription drug benefits based on your medical plan option.

Prospective and existing members can compare prescription plan options by using the interactive Drug Calculator Tool to find estimated drug costs by plan. The tool provides estimated costs through retail or mail, shows lower cost alternative drugs and any specific requirements, such as whether the drug requires a prior authorization before it can be filled. You can access the tool by selecting your plan below:

• BlueChoice Advantage—HDHP Option
• Blue Value Plus Option Tool
• Before you have met your deductible
• After you have met your deductible
• Standard Blue Choice

Cost effective medical care

Services	BlueChoice Advantage-HDHP Option	Blue Value Plus Option	Standard Blue Choice
Formulary	2024 CareFirst Prescription Formulary 2 (PDF) 2024 CareFirst Preferred Drug List Formulary 2 (PDF) 2024 $0 Select Generics (PDF) 2023 CareFirst Prescription Formulary 2 (PDF) 2023 CareFirst Preferred Drug List Formulary 2 (PDF) 2023 $0 Select Generics (PDF)	2024 CareFirst Prescription Formulary 4 (PDF) 2023 CareFirst Prescription Formulary 4 (PDF)	2024 CareFirst Prescription Formulary 2 (PDF) 2024 CareFirst Preferred Drug List Formulary 2 (PDF) 2023 CareFirst Prescription Formulary 2 (PDF) 2023 CareFirst Preferred Drug List Formulary 2 (PDF)
Rx Deductible	Combined Medical and Drug deductible ($1,600 Self-Only, $3,200 Self + One/Self and Family)	$100 Self Only $200 Self + One/Self and Family	$0
Pharmacy (Retail up to a 34-day supply)
Preventive Drugs Examples: folic acid, fluoride and FDA approved contraceptives for women	$0, no deductible	$0, no deductible	$0
Generic	$0, after deductible1	N/A	$0
Preferred Generic	N/A	$10, no deductible	N/A
Preferred Brand	$50, after deductible, $30 Insulin (no deductible)	$50, after deductible, $30 Insulin (no deductible)	$50, $30 Insulin
Non-preferred Brand	$75, after deductible, $30 Insulin (no deductible)	N/A	$75, $30 Insulin
Preferred Generic Specialty	N/A	$100, after deductible2	N/A
Preferred Brand Specialty	$100, after deductible2	$150, after deductible2	$1002
Non-preferred Specialty	$150, after deductible2	N/A	$1502

This summary is for comparison purposes only and does not create rights not given through the benefit plan.

¹Select generics not subject to deductible.

²Specialty drugs limited to 34-day supply for first fill and change in fills. Specialty drugs must be filled through CVS Specialty Pharmacy.

* Preferred Brand Insulin not subject to deductible