How to Check Your Drug Coverage

When your doctor says you need a prescription drug, one of your first thoughts may be, “How much will it cost me?” It’s an important thing to know, and there are several ways to find out.

You might think about checking with your doctor’s office, but there are many drugs and many health plans, so they may not know how much it will cost you.

It may be better to start by determining if your health insurance plan covers that particular medicine.

You can find basic information about pharmacy benefits on our website, but to get the details, you’ll need to check your specific health plan.

Check Your Plan Online

If you have prescription drug benefits with us, log in to Blue Access for Members^SM to check your drug list and learn more about your prescription drug benefits. Go to Pharmacy to find coverage and cost information for your drug.

A drug list is the list of drugs that are covered under your prescription drug benefit. How much you pay out of pocket is determined by whether your drug is on the list and at what coverage level, or tier. A generic drug is often at the lower tier. Some prescription drug plans may call for you to pay more if you fill a prescription for a brand name drug when a generic equivalent is available.

You can also use our free BCBSMT App to log in to BAM and check your prescription drug information. The BCBSMT App is available in English and Spanish from the Apple App Store  or Google Play .

Ask at the Pharmacy

Your pharmacist is a good resource if you want to know exactly what a medicine will cost you. When your doctor sends the prescription to the pharmacy, the pharmacy will check your insurance information on file when they fill your prescription. The pharmacy can tell you what you will pay and what your insurance may pay.

Finding Lower Cost Options

If the cost of your prescription is more than you expected, there may be ways to lower it.

You can ask the pharmacy if there are any other options. There may be a program to help with your costs, or another equivalent drug may be available. You can also check to see if prices are different at different pharmacies. 

You can also help keep your prescription drug costs down if you fill your prescriptions at an in-network pharmacy. To find an in-network pharmacy, log in to your BAM account and look under Pharmacy.

If you’ve been using a pharmacy that isn’t in your plan’s network, it’s easy to switch. You can take your prescription label to the new in-network pharmacy. Or you can call the new pharmacy and ask them to contact your current pharmacy. You can also ask your doctor to contact your new pharmacy. You may need to take your member ID card with you if it’s your first visit to the pharmacy or if you’ve changed plans.

You can also ask your doctor if a different, less expensive covered medicine is a good choice for what you need. Consider asking if there is a generic drug that would work.

What About Pre-approval?

Some drugs must be approved by your health plan before they will be covered. That’s to make sure they are safe and used correctly. Your doctor’s office or pharmacy will let you know when it’s needed.

If you’re told a drug needs pre-approval (sometimes called prior authorization), that does not mean it isn’t covered by your plan. It just means there is one more step in the process and more information is needed.

Originally published 1/2/2024; Revised 2024