Pharmacy Benefits and Information
Shingles Vaccine
Shingles, also known as zoster or herpes zoster, is a painful rash that can occur in any age group. However, about half of all cases occur among men and women 60 years old or older. There is a vaccine against shingles, and the State Health Plan covers the shingles vaccine at 100 percent. Members are responsible for the office visit copayment if the vaccine is administered by your provider.
If your doctor's office doesn't have the shingles vaccine, your doctor may write you a prescription to buy the vaccine at a pharmacy. You may then take the vaccine – which must be kept frozen until used – to your doctor for administering. The vaccine would have no copay; however, there would be an office visit copayment if administered by your provider.
Also, licensed and certified immunizing pharmacists in the Blue Cross and Blue Shield of North Carolina (BCBSNC) network are contracted to provide and administer vaccines, such as the flu, pneumonia and shingles in retail pharmacies. In order for a vaccine received in a retail pharmacy to be covered, it must be administered by an immunizing pharmacist participating in the BCBSNC network. To locate a participating in-network immunizing pharmacist, click here to visit the "Find a Doctor" section on the Plan's website.
Medical Adherence Pilot Program (MAPP)
To make it easier for members to stay healthy and take diabetes and cardiovascular medications as directed by providers, the State Health Plan is providing a special benefit to retirees called the Medication Adherence Pilot Program (MAPP). Under this pilot program, retired members taking medications for cholesterol, blood pressure and blood sugar can order a 90-day supply of their diabetes and heart medications from participating pharmacies for 2½ times the copay. This pilot program is voluntary. For more information, click here.
Saving Money with Pharmacy Benefits
Members have many opportunities to save money on medications. The first step is to clearly understand your pharmacy benefits, so you can talk to your health care provider about your best medication options. Two simple ways to save money on medications include replacing brand name prescriptions with generic alternatives and using over-the-counter (OTC) medications instead of prescription medications. For more tips, see our Ways to Save section, which includes information on low cost generic programs including the $4 lipid lowering medication benefit.
Preferred Drug List
The State Health Plan has a preferred drug list to promote clinically appropriate utilization of medications in a cost-effective manner. For more details, and a look at the most recent preferred drug list, please click here.
