Pharmacy Benefits and Information
Welcome to the State Health Plan's online resource for Pharmacy benefits. The Plan utilizes a Pharmacy Benefit Manager (PBM), which administers the prescription drug benefit. The current PBM for the State Health Plan is Express Scripts.
You will be required to pay the appropriate copay or coinsurance in accordance with State Health Plan benefits. When visiting a participating pharmacy, be sure to present your State Health Plan ID card to the pharmacy.
The State Health Plan has two prescription drug plans:
All members not eligible for Medicare are enrolled in this plan.
For questions regarding your Traditional Pharmacy Plan, please call Express Scripts Customer Service at 800-336-5933, or visit Express Scripts.
All Medicare-eligible members are automatically enrolled in this plan. This plan is comparable to the Traditional Pharmacy Plan and offers better coverage than a standard Medicare Part D Plan.
Beginning Nov. 1, 2012, Express Scripts Customer Service will be able to answer questions on your plan's specific prescription coverage and copay amounts. You may contact Express Scripts Customer Service at 877-680-4882, 24 hours a day, 7 days a week. TTY users should call 800-716-3231, or visit Express Scripts.
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.