Web2024 CareFirst Preferred Drug List Formulary 2 (PDF) Rx Deductible. Combined Medical and Drug deductible ($1,500 Self-Only, $3,000 Self + One, $3,000 Self + Family) $100 Self Only. $200 Self + One/Self and Family. $0. Preventive Drugs. Examples: folic acid, fluoride and FDA approved contraceptives for women. $0, no deductible. WebThe formulary is a covered drug list. It’s comprised of generic, brand name and specialty drugs. Drugs on the formulary are assigned to a tier. Your out-of-pocket cost will depend on the tier your drug is in. Formulary placement decisions are based on recommendations by the Pharmacy and Medical Policy Committee (PMPC) – an independent group ...
Medication Lookup Prescription Drug Search CareFirst
WebPlease contact your Tribal Benefits Officer for exact rates. Standard Option, Self Only, Enrollment Code 104: Premium Rate. Biweekly government share: $244.86. Biweekly your share: $127.47. Monthly government share: $530.53. Monthly your share: $276.19. Standard Option, Self Plus One, Enrollment Code 106: Premium Rate. WebWegovy ® (semaglutide) injection 2.4 mg is an injectable prescription medicine that may help adults and children aged ≥12 years with obesity (BMI ≥30 for adults, BMI ≥ 95th percentile for age and sex for children), or some adults with excess weight (BMI ≥27) (overweight) who also have weight-related medical problems to help them lose ... super 8 by wyndham hutchinson
2024 FEP Prior Approval Drug List - Caremark
WebJust key in the drug name and select the year (2024 or 2024). It will display costs for the drug for Basic, Standard, and FEP Blue Focus plans. I checked for Wegovy using 2024 and it said the price at a nearby CVS is $60 for a 28 day supply. It is $90 under BCBS standard if the mail service is used. CVS Caremark number: 1-800-624-5060. WebMember Cost with Medicare A & B Primary - This is the most you have to pay annually in cost-sharing (deductibles, copayments and coinsurance) for covered, in-network services in your FEHB plan when Medicare A and B is your … WebMar 30, 2024 · A drug list is a list of drugs available to Blue Cross and Blue Shield of Illinois (BCBSIL) members. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. These prescription drug lists have different levels of coverage, which are called "tiers". Generally, if you choose a drug that … super 8 by wyndham janesville wi