2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Section 5(f). Prescription Drug Benefits
Covered Medications and Supplies

Benefits Description

Medications to promote better health as recommended under the Patient Protection and Affordable Care Act (the “Affordable Care Act”), limited to:
 

• Iron supplements for children from age 6 months through 12 months
   
• Oral fluoride supplements for children from age 6 months through 5 years
   
• Folic acid supplements, 0.4 mg to 0.8 mg, for individuals capable of pregnancy
   
• Low-dose aspirin (81 mg per day) for pregnant members at risk for preeclampsia
   
• Aspirin for men age 45 through 79 and women age 50 through 79
   
• Generic cholesterol-lowering statin drugs

Note: Benefits are not available for acetaminophen, ibuprofen, naproxen, etc.

Note: Benefits for the medications listed on the previous page are subject to the dispensing limitations described on page 106 and are limited to recommended prescribed limits.

Note: To receive benefits, you must use a Preferred retail pharmacy and present a written prescription from your physician to the pharmacist.

Note: A complete list of USPSTF-recommended preventive care services is available online at: www.healthcare.gov/preventive-care-benefits. See pages 42-46 in Section 5(a) for information about other covered preventive care services.

Note: See page 117 for our coverage of smoking and tobacco cessation medications.


Standard Option - You Pay
Preferred retail pharmacy: Nothing (no deductible)

Non-preferred retail pharmacy: You pay all charges

Basic Option - You Pay
Preferred retail pharmacy: Nothing

Non-preferred retail pharmacy: You pay all charges