Pharmacy / Benecard
The Plan provides a prescription drug benefit through Benecard PBF. Upon your initial eligibility with the Plan you will receive a prescription drug card directly from Benecard. If you have questions about your prescription benefit you can call the Plan office or contact Benecard directly at 1-800-907-0700. Additional information is available on their website at www.benecardpbf.com
The plan is 3-tiered and your copayments vary depending on whether you use a generic drug, a Formulary (“preferred”) brand name drug, or a non-Formulary (“non-preferred”) brand name drug.
Your Retail and Mail Order Co payments
Important: If you use a brand name drug (whether preferred or non preferred) that has a generic equivalent, you will pay the copay for the brand name drug PLUS the difference between the cost of the brand name drug and the cost of the generic equivalent drug.
Non-Maintenance Medication
If your physician prescribes a non-maintenance medication you simply take your Benecard ID card to any participating retail pharmacy. Our network of participating pharmacies includes over 53,000 pharmacies nationwide. But note that Walgreen’s has been added as a participating pharmacy network. Retail prescriptions are limited to a 30-day supply. If you need more than 1 original fill, plus 2 refills, you must use the Maintenance Medication program. Filling prescriptions through the Maintenace Medication program means using either Benecard Central Fill or any In-network retail pharmacy.
Maintenance Medication
Maintenance medications are medications you take on an ongoing basis to treat chronic conditions like diabetes, high blood pressure, and arthritis.
If your physician prescribes a maintenance medication (prescription drugs that you are expected to take for an extended period of time) you fill your first prescription AND the next 2 refills at any participating retail pharmacy.
After your 2nd refill, your prescription may be filled through Benecard Central Fill. (For your convenience, you can also fill your maintenance medications at any In net work retail pharmacy.) After your initial fill and two refills, the Plan will cover maintenance medications only if you use Benecard’s Central Fill or your local in network retail pharmacy.
For information about how the mail order program works you can call Benecard at 1-800-907-0700 or the Health Plan at 1-215-440- 4421/4422. Your doctor can fax your prescription to Benecard at 1-888-907-0040. And you can order your mail order refills online at www.benecardpbf.com
Filing Maintenance Medications
When your doctor prescribes a maintenance medication, the Plan covers your original prescription plus the first 2 refills for a 30-day supply only. This gives you and your doctor a chance to confirm that the medication and the dosage are right for you. After the 2nd refill the Plan will provide coverage for a 90-day supply through the Maintenance Medication Program.
Step Therapy
Step Therapy is a program designed to encourage the utilization of generic medication alternatives for chronic medical conditions in order to control healthcare costs for patients and their plan sponsors. The program requires a patient to use a lower‐cost medication prior to using the “second‐line” or higher cost medication within the same therapeutic category.
A Step Therapy program requires a member to have tried a first line medication before a second line medication is approved for coverage. The list of therapeutic classes requiring step therapy includes specialty medications and is developed by doctors, pharmacists and experienced medical personnel. A sample of these classes includes proton pump inhibitors, hypertension, sedative hypnotics, rheumatoid arthritis and transplant medications.
Filling your Prescription
If you fill your prescription at a network pharmacy, you do not need to file any claim forms. Just be sure your pharmacist has a copy of your Benecard identification card and they will handle claim submission.
If you fill your prescription at a pharmacy that is not part of the Benecard network, or if you fill your prescription at a participating pharmacy but fail to use your Benecard ID number, you will be charged the total cost of the prescription at the time it is filled. You will need to file a claim with Benecard for reimbursement. And note that your reimbursement will be based on what the Plan would have paid – which may differ significantly from what you paid.
Over The Counter (OTC)
Special provisions apply to certain OTC medications, providing plan coverage and minimal copays. Note that you will need a prescription from your doctor if you want the Plan to cover the following OTC drugs:
- $ 0 copayment
- Prilosec 20 OTC
- Nexium OTC
- $1 copayment
- Prevacid OTC
- Allegra OTC
- Claritin OTC (brand and generic)
- Zyrtec OTC (brand and generic)
Simply present your doctor’s prescription and your Benecard ID card if you obtain any of these OTC medications.
Covered Prescription Drugs
The Plan covers medications, products or devices that have been approved by the Food and Drug Administration (FDA). This includes federal legend drugs, state legend drugs, compounded medications, insulin, and injectables.
Prescription Drug Charges Not Covered
There are some prescription drugs that are excluded from coverage under the Plan, including:
- Except as noted above, over the counter (OTC) drugs, vitamins and supplements that may be prescribed by a physician but which can be obtained without a prescription
- Prescription drugs when there is an OTC equivalent
- Fertility drugs
- Cosmetic products
- Drugs prescribed by anyone other than a licensed physician
- Prescription drugs dispensed by anyone other than a licensed pharmacist
- Drugs administered while you are an inpatient in the hospital
- Drugs that are prescribed for a diagnosis other than approved by federal or state law
- Drugs for which coverage is available from some other source, including (but not limited to) worker’s compensation, government programs, occupational disease laws
- Prescriptions that you try to refill too soon.
Diabetic prescription drugs and supplies
The Plan covers insulin through Benecard under our prescription drug plan. Diabetic supplies, including lancets and glucose monitors, are covered through Independence Blue Cross. For additional information please call the Health Plan at 215- 440-4421 or 215-440-4422.
For more information contact Benecard at
- Link – www.benecardpbf.com
- 1-888-907-0070
FAQ – Pharmacy
Can I fill my prescriptions at any Pharmacy?
The Benecard network of participating pharmacies includes over 53,000 pharmacies nationwide. But note that Walgreen’s has been added as a participating pharmacy network.
How do I get my Maintenance Prescriptions?
If your physician prescribes a maintenance medication (prescription drugs that you are expected to take for an extended period of time) you fill your first prescription AND the next 2 refills at any participating retail pharmacy.
After your 2nd refill, your prescription must be filled through Benecard Central Fill. (For your convenience, you can also fill your maintenance medications at any IN-Network retail pharmacy.) After your initial fill and two refills, the Plan will cover maintenance medications only if you use Benecard’s Central Fill or Any In-Network retail pharmacy. You can order your mail order refills online at www.benecardpbf.com or directly from your In-Network Pharmacy.
