This page provides information related to HALO’s Prescription Drug Coverage, which comes automatic with your enrollment in a BCBS IL Medical Plan. Effective 9/1/2023, HALO’s Pharmacy Benefits Manager is CVS Caremark. This does not mean you are limited to just CVS for retail prescription refills.
- See the Participating National Network Retail Pharmacy Listing for National Network Retail Partners.
- If you are enrolled in the HDHP, you pay 100% of the allowed cost of the medication, until the deductible has been met. The cost you pay may be different, depending on the pharmacy you utilize. To understand where to get the lowest-cost medication, please utilize the cost estimator tool on CVS’ website.
Your BCBS IL Medical ID will contain the Prescription Drug Coverage ID information needed for you to refill your medication.
Understanding the plan: See the Summary Plan Description for information on how your coverage works.
Retail Prescriptions can be filled at any in-network pharmacy.
Issues accessing your account? Call 844-256-4046
Mail Order Prescription Benefits (90-day supply) are also filled through your CVS Caremark Account. See how to Manage Your Rx Delivery, along with an FAQ around the Mail Order Service.
- Rx Delivery by Mail is a safe and convenient way to get the medications you take regularly (like high blood pressure or diabetes medication). Because CVS delivers in 90-day supplies, you’ll need a new prescription from your doctor. The easiest way is to ask your doctor to send a 90-day prescription to CVS Caremark Mail Service Pharmacy. Or, CVS can contact your doctor and start the process for you!
Specialty Prescriptions must be filled through CVS Specialty.
- For condition-specific support, you can create an account on CVSspecialty.com/go.
- This gives you access to support and other resources. You will still need to create a Caremark.com account to manage your prescription.
- This login is different from your Caremark.com account.
- Review the Advanced Control Specialty Formulary to understand how your drug is covered.
- See the Specialty New Patient Guide, which goes hand-in-hand with your new prescription. It introduces you to CVS Specialty and how CVS helps you manage your condition as well as your health.
- For additional resources, please see the CVS Specialty Program FAQ.
Additional Benefits
Additional Benefits:
Your No-Cost Preventive Medications: These no-cost benefits are part of the Affordable Care Act (ACA). They include:
- Medicine and supplements to prevent certain health conditions for adults, women and children
- Medicine and products for quitting smoking or chewing tobacco (tobacco cessation)
- Medicine used prior to screenings for certain health conditions in adults
- Vaccines and immunizations to prevent certain illnesses in infants, children and adults
- Contraceptives for women
CVS Caremark works with your health plan to provide these benefits. Review the ACA Preventive Services List, which helps explain:
- Which medicines, supplements, health-related products or vaccines are covered
- Who they are covered for (such as children up to age six or adults age 65 or older)
- What health condition or illness they help prevent
Vaccinations: HALO is covering all ACA non-seasonal vaccinations which are available at any in-network participating pharmacy. Learn more or schedule your vaccination here.
Diabetes Management: The Diabetic Meter Program provides eligible members with a blood glucose meter, at no out-of-pocket cost. Learn more here.
Prescription Resources
Prescription Resources:
Specialty Rx Specific Resources:
Quick Tip Videos:
Savings Programs
Patient Assistance Program (Specialty Medications): This program can help you acquire your medication at no cost, directly through the manufacturer. Eligible members will be contacted to apply for the program.
- You may be contacted after filling Specialty Medications to participate in the program. If you are identified as eligible, an ImpaxRx Prescription Advocate will be reaching out directly to you to determine if you will qualify to receive your high-cost medication at no cost to you.
- See the Patient Assistance Program Flyer to learn more.
Specialty Copay Assistance Program (Specialty Medications): This program helps reduce your Specialty Prescription Spend. Eligible members will be contacted to apply for the program.
- When using the Manufacturer copay assistance dollars will not apply to your deductible and maximum out of pocket.
- See the Specialty Copay Assistance Flyer to learn more.
Prescription Requirement Definitions
Prescription Definitions: To learn more, please see the Applicable FAQ, and click Formulary, Prior Authorization, Quantity Limits, or Step Therapy.
- A Formulary is your plan’s list of covered medications. The formulary is designed to help you get the medication you need at the lowest possible cost. While it doesn’t include every available medication, it includes options to treat most health conditions. When your doctor prescribes a formulary medication, you’ll pay your plan’s required copay or coinsurance at the pharmacy.
- Prior authorization (PA) is an extra layer of review that’s needed for some medications. If PA is required, your doctor will need to provide information on why they are prescribing this medication for you. Depending on the medication, your doctor may need to provide your diagnosis, results of lab tests, or other information from your medical record.
- Quantity Limits A quantity limit is the highest amount of medication covered by your plan for a period of time (for example, 30 tablets per month). Your plan will cover your medication up to the limit. Once the quantity limit is reached, you’ll have to pay the full cost of the medication. Quantity limits are sometimes used to help make sure a medication isn’t overused or to help save money for you and your plan.
- Step therapy is when your plan requires you to try an alternative medication (often lower cost) before “stepping up” to a medication that works to treat your condition in a similar way but may cost more. Once you try the alternative medication, you can choose to keep taking (if it works for you) or change back to your original medication.
