Blue cross blue shield of michigan prescription coverage

Questions About Your Benefits?

Call the SSC Contact Center at 5-2000 from the Ann Arbor campus, (734) 615-2000 locally, or (866) 647-7657 toll free, Monday through Friday from 8 a.m. to 5 p.m.

Limitations

The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend, or terminate them. Every effort has been made to ensure the accuracy of the benefits information in this site. However, if any provision on the benefits plans is unclear or ambiguous, the Benefits Office reserves the right to interpret the plan and resolve the problem. If any inconsistency exists between this site and the written plans or contracts, the actual provisions of each benefit plan will govern.

Health and Prescription Drug Plans

  • State Health Plan PPO
    Blue Cross Blue Shield
    of Michigan (BCBSM)
    800-843-4876
    www.bcbsm.com/som

    CY2023

    • Rates
    • Plan Summary

    CY2022

    • Rates
    • Plan Summary
            

    Behavioral Health/Substance Use Disorder (BH/SUD) Administrator for the State Health Plan PPO
    Blue Cross Blue Shield of Michigan (BCBSM) in partnership with New Directions

    Inquiries for Benefits, Claims, or ID Cards
    800-843-4876 (BCBSM)

  • Catastrophic Health
    Blue Cross Blue Shield of Michigan (BCBSM)
    800-843-4876

    Discontinued effective 1/1/23

    CY2022

    • Rates
    • Plan Booklet

Additional Health Plan Resources

Dental and Vision Plan Resources

Flexible Spending Accounts, Long Term Disability, and Life Insurance Plans

Flexible Content

Prescription Drug Coverage (Part D)

Medicare Prescription Drug plans are offered by private health insurance companies and cover your prescription drug costs for covered medications. 

You can choose to receive this coverage in addition to:

  • Original Medicare (Part A and Part B)
  • Original Medicare (Part A and Part B) with a Medigap Plan

Part D coverage is generally included in most Medicare Advantage (Part C) plans.

Costs

PremiumMost Part D plans require a monthly premium.
DeductibleSome plans have deductibles.
CopaysMany Part D plans require that you pay a fixed copayment each time you fill a prescription.
CoinsuranceSome Part D plans require that you pay a percentage (coinsurance) of a medication’s cost every time you fill a prescription.
Coverage GapAlthough plan designs can vary, most Medicare Part D plans have a cost sharing component commonly known as a coverage gap or “donut hole.” The coverage gap is a temporary limit where you are responsible for all of your drug costs until you reach the plan’s annual out-of-pocket limit. After you reach that limit, you will pay only a small share of your prescription costs for the remainder of the year.

Limits and Considerations

Limits

Most Part D plans have “formularies,” which are lists of covered prescription drugs. Part D plans also have networks of approved pharmacies in your area.

Things to Consider 

  • Costs for Part D plans can vary, so choose a plan that meets your needs and budget.
  • Part D insurance premiums may change each year. You will be notified of these changes in the fall prior to the annual Open Enrollment Period.
  • Medicare Part D has a low-income subsidy program, and Medicare beneficiaries may qualify for financial assistance with the cost of their medications based upon their income and assets.

Initial Enrollment Period

The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Parts A or B, you can select other coverage options like a Prescription Drug Coverage (Part D) plan from approved private insurers. After this period has ended, you can add or change your coverage during the Open Enrollment Period.

How to Enroll

You must be entitled to Part A or enrolled in Part B, and you must live in the designated geography of the plan you want to enroll in before joining a Medicare Part D plan. Contact your local Blue Cross Blue Shield company for help choosing a Medicare Part D plan and getting enrolled.
 

Open Enrollment Period

October 15 through December 7

Open Enrollment runs from October 15 through December 7 and it provides an annual opportunity for Medicare-eligible consumers to review and make changes to their Medicare coverage. This includes the opportunity to select or make changes to Prescription Drug Coverage (Part D). However, if you elect to receive Part D coverage after your Initial Enrollment Period window closes, a late enrollment penalty may be added to your premium.


Download the Medicare Advantage (Part C) and Prescription Drug Plans (Part D) guide to find the coverage options offered by your local Blue Cross Blue Shield company.

What pharmacy does Blue Cross Blue Shield of Michigan use?

Blue Cross Blue Shield of Michigan and Blue Care Network members enrolled in the Exclusive Specialty Pharmacy Program should use AllianceRx Walgreen Pharmacy mail-order pharmacy or Walgreens retail stores to fill specialty drug prescriptions. Other pharmacies are considered out-of-network for specialty drugs.

Does BCBS of Michigan use Express Scripts?

The change will take effect on different days depending on membership type. On Jan. 1, 2022, Express Scripts will no longer be BCBS of Michigan's pharmacy benefit provider for commercial individual and group members. The change will occur on Jan.

How can I save on prescription drugs?

10 Resources To Help You Save On Prescriptions.
Work With Your Pharmacist. ... .
Get Familiar with NeedyMeds and RXAssist. ... .
Consider Generic Drugs. ... .
Buy in Bulk: Get a Prescription for a 90-Day Supply. ... .
Go Directly to the Drug Manufacturer for Discounts. ... .
Grab a Free Prescription Savings Card. ... .
Use an Online Mail-Order Pharmacy..

Is Express Scripts cheaper than pharmacy?

As a result of the company's negotiations on mail order pricing, retail pharmacies' prescriptions cost on average 10 percent more than the Express Scripts Home Delivery pharmacy.