How your pharmacy benefits work
Bring your Blue Cross and Blue Shield of North Carolina (Blue Cross NC) member ID card to your in-network pharmacy along with a prescription from your doctor. You can also ask your doctor to send the prescription straight to your pharmacy.
Your pharmacist will automatically send a claim to Blue Cross NC. Once the claim processes, Blue Cross NC may cover a portion of the total cost without any additional paperwork required. Depending on your coverage, you may only be responsible for paying a copay.
Understanding prescription drug costs
Some prescription drug benefits require you to pay a reduced cost – referred to as a copay – when picking up medications. The rest of the cost is covered by your health insurance plan.
Drugs come in 3 forms: brand-name, generic, and specialty. Most generic drugs have a lower copay, while specialty drugs tend to have the highest copay.
Search for drug coverage
Individual under 65 drug search
Use our drug search tool to find a list of covered drugs and medicines that may need need a prior authorization. You can search for prescription drugs, such as generics, brand-names, and speciality medicines.
Medicare drug search
On our Medicare prescription drug resources page, you can find a list of drugs covered under each plan, called a formulary. You can also search for drugs to find out if they require prior authorization from your doctor.
Non-formulary drugs
Sometimes, doctors prescribe a medication not on your plan's approved list. These are called non-formulary drugs. Doctors may prescribe non-formulary drugs when covered medications don't work for you.
Additional prescription drug resources
Individual and family members (under age 65)
The Blue Cross NC mail order prescription program offers you the convenience of receiving up to a 90-day supply of medication delivered to you with free standard day shipping through Amazon Pharmacy (MedsYourWay®) and Express Scripts® Pharmacy (ESI). You can order your prescriptions online or through the mail – choose whatever works best for you.
For MedsYourWay, Amazon Prime members get free 2-day delivery; 5-day delivery without Amazon Prime. Follow the easy sign-up process at Amazon or call 855-963-4546. If you are not already an Amazon customer then you’ll need to sign up, confirm your identity and then follow the instructions.
For ESI, register online at Express Scripts or call 833-599-0450.
Medicare members (age 65+)
The Blue Cross NC mail order prescription program offers you the convenience of receiving up to a 90-day supply of medication delivered to you with free standard day shipping. Typically, you should expect to receive your prescription drugs within five to fourteen days (using standard shipping) from the time that the mail order pharmacy receives the order.
Learn more about getting prescriptions by mail for Medicare members.
Frequently asked questions
Reimbursement varies per plan. Please refer to your Member Guide to find out if benefits are available for out-of-network pharmacies.
Our prescription drug mail service is provided by Prime. You can order your prescriptions online or through the mail.
A generic drug is identical, or bioequivalent, to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. However, depending upon your benefit design, you may substantially lower your out-of-pocket cost by using a generic drug instead of the brand name one.
Point of Blue Blog
Our blog, Point of Blue, can help you navigate your prescription drug coverage, save money on medications, and more.
Disclosures:
Prime Therapeutics is an independent company that is solely responsible for providing pharmacy benefit management services. Prime Therapeutics does not offer Blue Cross or Blue Shield products or services.
Amazon Pharmacy does not dispense controlled substances (Schedule 2 medications). Amazon Pharmacy is an independent company that is solely responsible for the services they provide. Amazon Pharmacy does not offer Blue Cross or Blue Shield products or services.
MedsYourWay is a prescription drug discount card, administered by Inside Rx® LLC. MedsYourWay discount card pricing is built into the Amazon Pharmacy shopping experience. You are responsible for the cost of your prescription(s) when using the MedsYourWay card. Limitations apply. Inside Rx LLC is an independent company that is solely responsible for the services it provides and does not offer Blue Cross or Blue Shield products or services.
Express Scripts Pharmacy is an independent company that is solely responsible for the pharmacy services it is providing. Express Scripts Pharmacy does not offer Blue Cross or Blue Shield products or services.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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