Benefits » Health Insurance » Prescription Drugs
Your Blue Cross and Blue Shield of New Mexico health plan also includes a prescription drug benefit administered by Prime Therapeutics.
LANL employees and retirees covered by the National EPO, National PPO, National Consumer-Directed Health Plan (CDHP), and Medicare Supplement Plans have 3-tier prescription drug benefits. With the 3-tier Rx coverage, your copayment is based on whether you are receiving a generic drug or a brand-name drug AND whether the drug is on our Drug List.
The cost of the prescription drug benefits are included in your medical premiums. Your copayment will vary depending on the type of medical plan you have and whether the drug is formulary or nonformulary, generic, or brand/preferred name.
You have a 3-Tier Prescription Drug Plan. Your copayment for prescription drugs is based on whether the drug you receive is a generic or a brand-name drug AND whether the drug is on the BCBSNM Drug List.
| Type of Prescription | Copay Level | Retail Pharmacy Copay* | Mail-Order Program Copay** |
|---|---|---|---|
| Generic Drugs | Tier 1 | $15 | $30 |
| Brand-Name Drugs | Tier 2 | $30 | $60 |
| Brand-Name not on Drug List | Tier 3 | $45 | $90 |
*Retail Pharmacy – copay is for a 30-day supply or 180 units, whichever is less.
**Mail-Order Pharmacy Program – copay is for up to a 60-day or 90-day supply or 540 units, whichever is less.
Benefits also include flu, pneumococcal, and Zostavax vaccines, for which you pay no copayment.
You have a 3-Tier Prescription Drug Plan. Your copayment for prescription drugs is based on whether the drug you receive is a generic or a brand-name drug AND whether the drug is on the BCBSNM Drug List.
| Type of Prescription | Copay Level | Retail Pharmacy Copay* | Mail-Order Program Copay** |
|---|---|---|---|
| Generic Drugs | Tier 1 | $15 | $30 |
| Brand-Name Drugs | Tier 2 | $30 | $60 |
| Brand-Name not on Drug List | Tier 3 | $45 | $90 |
*Retail Pharmacy – copay is for a 30-day supply or 180 units, whichever is less.
**Mail-Order Pharmacy Program – copay is for up to a 60-day or 90-day supply or 540 units, whichever is less.
Benefits also include flu, pneumococcal, and Zostavax vaccines, for which you pay no copayment.
You have a Percent/Coinsurance Drug Plan. Once your deductible is met, BCBSNM pays 80 percent and you pay 20 percent of the covered charge for generic and brand-name drugs.
| Type of Prescription | Percentage You Pay |
| Retail Pharmacy: Up to a 30-day supply or 180 units, whichever is less. |
|
| Generic drug | 20% |
| Brand-name drug* | 20% |
| PrimeMail Pharmacy Mail-Order Service: Up to a 90-day supply or 540 units, whichever is less. |
|
| Generic drug | 20% |
| Brand-name drug* | 20% |
| Prior-approved enteral nutritional products and special medical foods. | 20% |
*If you request a brand-name drug when a generic is available, you will pay 20% plus the difference in cost between the brand-name and generic.
Benefits also include flu, pneumococcal, and Zostavax vaccines, for which you pay no copayment.
The Percent/Coinsurance Drug Plan does not use the BCBSNM Drug List.
Your prescription drug benefit also includes an option for mail order prescription services through Prime Therapeutics PrimeMail. You will need to have a prescription written for a three-month supply of the medication you are ordering. To order, use the PrimeMail order forms.
To access your prescription drug benefit plan information use the following steps:
Step 1: Log-in to the Blue Cross Blue Shield of New Mexico Blue Access member website by clicking here.
Step 2: Once you have created a Blue Access member log-in, do one of the following:
(Note: In addition to the above two steps, you may also choose to create an additional log-in using the Prime Therapeutics website. Please note that if you choose this option you must create a Blue Access member log-in prior to creating a Prime Therapeutics log-in).
For more information, please review the Blue Cross Blue Shield of New Mexico Online Tools: Prescription Drug Information flyer (pdf).
Prescription Drug Supply Limits
| Order Type | Frequency | Supply | Your Cost |
|---|---|---|---|
| Mail order (Prime Therapeutics PrimeMail) | Three months | 32–90 days | 2 copayments |
| Retail pharmacy | One month | ≤ 31 days | 1 copayment |
This is only an overview of your prescription drug benefits for more detail contact either BCBSNM 1-877-878-5265 or Prime Therapeutics 1-877-357-7463.
Questions? Contact the Lab’s Benefits Office at 505-667-1806.