Prescription Drug Coverage

Prescription drug coverage is included in your medical plan. For details about the prescription drug plan, including copayment explanations, exclusions, limitations and how the plan works, please see the Plan Contracts.

Prescription Drug Formulary (Beginning July 1^st, 2024)

For FY2025, the State of Idaho health plan will transition from a four-tier drug list – sometimes called a formulary – to a customized six-tier drug list. It’s important to note that there may be a difference in how certain drugs are classified compared to previous years. For more information on the change in drug tiers, please review the New 6-Tier Benefit flyer.

The best way to confirm any changes is to search for your medication on the current Blue Cross drug list and compare it to the Regence 6-Tier Drug List. You can also access an up-to-date, searchable database of medications and treatments when you log into the member portal at Regence.com.

 

Six-Tier Drug Formulary – PPO and Traditional Plans

Formulary Tier	Copay
Tier 1 – Preferred generics (typically the least costly at the pharmacy)	$10
Tier 2 – Generics and some lower-cost brand products
Tier 3 – Preferred brand-name drugs that are typically less costly	$30
Tier 4 – Typically high-cost brand-name drugs	$60
Tier 5 – Preferred specialty medications; may include lower-cost brand or generic specialty medications
Tier 6 – Higher-cost specialty medications; may include higher-cost brand or generic specialty medications	$100

Six-Tier Drug Formulary – HDHP Plan 

Formulary Tier	Coinsurance
Tier 1 – Preferred generics (typically the least costly at the pharmacy)	20%
Tier 2 – Generics and some lower-cost brand products
Tier 3 – Preferred brand-name drugs that are typically less costly
Tier 4 – Typically high-cost brand-name drugs
Tier 5 – Preferred specialty medications; may include lower-cost brand or generic specialty medications
Tier 6 – Higher-cost specialty medications; may include higher-cost brand or generic specialty medications

Important Note for HDHP Members: The costs for all prescriptions not listed on the Optimum Value Medication List are subject to the HDHP deductible. Benefits will not begin until the deductible is met on the HDHP plan.

Specialty medication from Accredo

Regence partners with Accredo to offer medication and support for members managing complex health issues.

Beginning July 1, 2024, members with specialty medications will work with Accredo to manage their prescription needs. Members will also have the option to fill specialty medications at AllianceRx Walgreens Pharmacy.  

To confirm your specialty medication is covered and has transferred correctly, please contact Accredo at 1-833-599-0514.

Convenient home delivery with Amazon MedsYourWay

Save money and time when you use Amazon Pharmacy with the MedsYourWay discount. Take advantage of home delivery for covered maintenance medications, preventive prescriptions and over-the-counter medications. With Amazon Home Delivery, you can expect:

• Up to 90-day refills at a time
• Free 5-day shipping; 2-day for Amazon Prime members
• Discreet packaging
• 24/7/365 access to pharmacists
• Ability to use your health savings account dollars

Visit Amazon.com/regenceIDMYW and use the information on your Regence member ID card to get started.