Frequently Asked Questions
Often two brand name drugs help treat the same problem, but one has been shown to be more cost- or medically effective than the other. That more effective drug becomes a preferred drug and the other becomes a non-preferred drug. Decisions to determine whether a medication is preferred or non-preferred are made by an independent group of physicians.
Under the three-tier copayment benefit, all of the products on the formulary are covered. Members will have to pay a higher copayment for non-preferred products. Decisions to determine whether a medication is preferred or non-preferred are made by an independent group of physicians and pharmacists.
Generic drugs are the un-branded form of a prescription medication. They use the same active ingredients as brand name drugs and work the same way.
The FDA puts all generic drugs through a rigorous, multi-step process to ensure that they are the therapeutic equivalent of their brand name counterparts. That means that a generic drug can be substituted for a brand name drug and it will produce the same clinical effect while meeting the same safety profile as the brand name drug.
Learn more and see how much members could be saving on our Generic Drugs page.
Members who have mail service as part of their pharmacy coverage and take medicine on an ongoing or regular basis may benefit from PrimeMail. To learn more about the program and how to get started, visit our Prescriptions by Mail page.
Horizon BCBSNJ has a broad pharmacy network that consists of tens of thousands of pharmacies nationwide, conveniently allowing members to use pharmacies in other parts of the country. This extensive network includes many major chains and most independently owned stores. To find an in-network pharmacy, use our Pharmacy Finder
Setting up the prescriptions by mail service can have a number of benefits, depending on your prescription or health benefit plan. In general, the service provides easy, in-home delivery and lets you refill prescriptions and check the status of your order through Member Online Services.
With some plans, receiving your prescriptions by mail also features a lower copayment. Call the pharmacy member services number located on the back of your member ID card for more information on your plan.
The Horizon Pharmacy and Therapeutics Committee is an independent group of physicians that regularly reviews new and existing drugs and evaluates them based on clinical safety and efficacy. This committee makes decisions that determine the formulary status of medications.