Prescription Drug Coverage

Your Prescription Drug program is designed to provide you with affordable access to both generic and brand-name drugs.

The amount that you pay out-of-pocket (your co-pay) will vary as noted below. Members who have MHIP+ will pay less. The MHIP Application Booklet outlines the cost differences for MHIP+ members.

Note – PPO plans have a separate annual deductible for pharmacy services (based on your plan year, not the calendar year). Once the deductible has been met, you will pay the applicable co-pay listed below.

  • Tier 1 – Generic Drugs -- $20 for a 31-day supply/$40 for a 90-day supply
  • Tier 2 – Preferred Brand-Name Drugs; $27 for a 31-day supply/$54 for a 90-day supply
  • Tier 3 – Nonpreferred Brand-Name Drugs -- $47 per prescription/$94 for a 90-day supply

Note:  If you select a brand-name drug when a generic is available, you will pay the nonpreferred brand (Tier 3) co-pay, PLUS the difference in cost between the generic and brand-name drug.

Maintenance Drugs

You will pay less for your maintenance drugs if you buy a 90-day supply instead of buying a monthly supply.

Maintenance Drugs List

Mail Order

Members who prefer the convenience of mail order, can order their drugs through Walgreens Mail Order Services. Please visit the Walgreens Mail Order Web site for members of CareFirst plans for more information.

Pre-Authorization

Certain drugs require approval from MHIP before you can get them from the pharmacy. This process is called pre-authorization.

Drugs Requiring Pre-authorization

Quantity Limits

Some drugs have limits on the amount of the drug you can get during a specific time period. These are called quantity limits

Quantity Limit List
CareFirst BlueCross BlueShield CareFirst BlueChoice

MHIP is administered by CareFirst BlueCross BlueShield and CareFirst BlueChoice, independent licensees of the BlueCross BlueShield Association.