To find a pharmacy in the Caremark Network, please click this link: https://info.caremark.com/oe/ogb and scroll down to Find a Pharmacy in Your Area.

To check the cost of a prescription drug or if a drug is on the Caremark formulary, click the appropriate link below:

Active employees/non-Medicare retirees: https://info.caremark.com/oe/ogb
Medicare retirees: https://info.caremark.com/oe/ogbmedicarerx

PHARMACY BENEFITS – PELICAN HRA1000 & MAGNOLIA PLANS

These plans use the CVS Caremark formulary. The formulary is reviewed regularly to reassess drug tiers based on the current prescription drug market. Members will continue to pay a portion of the cost of their prescriptions in the form of a co-pay or coinsurance. The amount members pay toward their prescription depends on whether or not they receive a generic, preferred brand, non-preferred brand or specialty drug.

Tier

Member Co-Pay*

Generic

50% up to $30

Preferred

50% up to $55

Non-Preferred

65% up to $80

Specialty

50% up to $80

Once you pay $1,500:

Generic

$0

Preferred

$20

Non-Preferred

$40

Specialty

$40

*Member responsibility is for a prescription drug benefit of up to a 31-day supply.

PHARMACY BENEFITS – PELICAN HSA775

Blue Cross and Blue Shield of Louisiana works in partnership with Express Scripts® to administer your prescription formulary drug program for the Pelican HSA775. Prescriptions are subject to the plan deductible with the exception of maintenance medications.

Tier

Member Co-Pay*

Generic

$10

Preferred

$25

Non-Preferred

$50

Specialty

$50

*Subject to deductible and applicable co-payment. Maintenance drugs are not subject to the deductible.

Click on the links below for more information on the pharmacy benefits through Express Scripts.

Express Scripts 2022
Maintenance/Preventative Drug List
Blue Selections – Rx Member Guide

 

PHARMACY RESOURCES




Caremark

1-877-300-1906

24 Hours, Seven Days a Week

Caremark Member Website

Silverscript

1-888-996-0104

24 hours

Seven Days a Week

Silverscript Member Website

Reimbursement Claims Form

Prior Authorizations and Appeals Program

Advanced Control Specialty Formulary

Performance Drug List-Standard Control for Clients with Advanced Control Specialty Formulary

Medicare Part D Formulary (Feb. 2024)

Express Scripts (Pelican HSA775)

http://www.express-scripts

1-866-781-7533

Seven Days a Week

Medicare Retiree Formulary

Express Scripts Rx Checker

Pelican HRA1000 Pharmacy Benefits

Magnolia Local Plus Pharmacy Benefits

Magnolia Open Access Pharmacy Benefits

Magnolia Local Pharmacy Benefits

SilverScript Benefits for Medicare Retirees

Caremark Diabetic Meter

Caremark Digital Tools

Caremark Mobile App