• June 12, 2021

BCBS Prescription Copay

Medical Plan Choice BCBS PPO Blue Plan BCBS PPO Blue Plan
Prescriptions Retail
30 day supply
Mail Order
90 day supply
Retail
30 day supply
Mail Order
90 day supply
Tier 1 $10 $20 80%* 80%*
Tier 2 $30 $60 80%* 80%*
Tier 3 $60 $120 80%* 80%*
Tier 4 $90 $180 80%* 80%*

* = After deductible

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