If you enroll in this plan, you must receive your medications from a Blue RX pharmacy (except in an emergency or when you are temporarily living out of Iowa) in order to receive coverage. Blue RX is a network of pharmacies. Check for pharmacy locations near you.

If you receive your medication from a Blue RX Preferred pharmacy you will pay only the co-payment or co-insurance amount of the billed charge. If you receive your medication from a non-Blue RX Preferred pharmacy, the pharmacy is not responsible for submitting your prescription claims. You will pay for the prescription upon receipt and then submit a reimbursement form to Blue Cross/Blue Shield.

For each prescription, you will pay:

Tier 1: Generic formulary — 25% co-insurance
Tier 2: Name brand formulary drugs — 30% co-insurance
Tier 3: Name brand non-formulary drugs — 50% co-insurance

Formulary drugs are drugs that are on Wellmark's preferred list. The maximum benefit payable is $500 for single and $750 for all other contracts.

If a brand name drug is purchased when a generic equivalent is available, you are responsible for your coinsurance, plus any difference between the billed charge for the brand name drug and the billed charge for the generic. This can result in you paying substantially higher costs than if you had chosen the generic drug.

If your physician feels it is important for you to have the brand name drug instead of the generic equivalent, the physician can write a prescription for the brand name drug with the direction, "Dispense as written." In this situation you will not be responsible for the difference between the billed charge for the brand name drug and the billed charge for the generic drug.

Services Covered by the Prescription Drug Plan

• Prescription drugs (unless specifically excluded)
• Prenatal vitamins
• Prescription contraceptives and devices
• Prescription smoking cessation drugs
• Prescription drugs used as part of home health care services
• Insulin
• Disposable syringes and needles for the injection of insulin
• Glucose monitoring strips/lancets
• EpiPen
• Imitrex

Services Not Covered by the Prescription Drug Plan

• Prescription drugs received from a non-Blue RX pharmacy, except in an emergency or when temporarily living out of Iowa
• Prescription drugs administered by injection with the exception of insulin, EpiPen, and Imitrex
• Most over-the-counter drugs
• Therapeutic devices and appliances, including hypodermic syringes, except disposable syringes and needles for the injection of insulin
• Nutritional supplements, including vitamins (except for prenatal vitamins)
• Investigational drugs labeled "Caution: Limited by Federal Law to Investigational use"
• Drugs not medically necessary for the treatment or prevention of illness, injury, or other covered condition
• Drugs used for cosmetic purposes (e.g., tretinoin (Retin-A) for treatment of skin aging, minoxidil (Rogaine) for stimulation of hair growth)
• Drugs dispensed by a person authorized to prescribe drugs (e.g., physicians, dentists and advanced registered nurse practitioners.)
• Drugs obtained outside the United States
• Charges for drugs covered by Worker's Compensation laws or other federal, state, or county programs