Pharmacy Benefits

PEEHIP's Pharmacy Benefits are administered by MedImpact for PEEHIP's Active Members and Non-Medicare-Eligible Retirees who are enrolled in the PEEHIP Blue Cross Blue Shield Group #14000 Hospital Medical Plan.

Formulary Drug List

Other Pharmacy Benefit Information

Prescription Benefit Copays Administered by MedImpact

Tier 1 - Generic:

  • $6 copay (1-30 day supply)
  • $12 copay (31-90 day supply)

Tier 2 - Formulary (preferred brand name):

  • $40 copay (1-30 day supply)
  • $80 copay (31-60 day supply)
  • $120 copay (61-90 day supply)

Tier 3 - Non-formulary (non-preferred brand name):

  • $60 copay (1-30 day supply)
  • $120 copay (31-60 day supply)
  • $180 copay (61-90 day supply)

Tier 4 - Specialty Drugs

  • 20% coinsurance per prescription, with a minimum of $100 copay and maximum of $150 copay (1-30 day supply)
  • Days supplies greater than 30 are not allowed for specialty drugs (31-60 day supply)
  • Days supplies greater than 30 are not allowed for specialty drugs (61-90 day supply)
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