FEHB Standard and Basic Options
2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5(f). Prescription Drug Benefits
Page 105
Section 5(f). Prescription Drug Benefits
Page 105
Benefit Description
Covered Medication and Supplies (cont.)
Specialty Drug Pharmacy Program
We cover specialty drugs that are listed on the Service Benefit Plan Specialty Drug List. This list is subject to change. For the most up-to-date list, call the phone number below or visit our website, www.fepblue.org. (See Section 10 for the definition of "specialty drugs.")
Each time you order a new specialty drug or refill, a Specialty Drug pharmacy representative will work with you. See Section 7 for more details about the Program.
Note: Benefits for the first three fills of each Tier 4 or Tier 5 specialty drug are limited to a 30-day supply. Benefits are available for a 31 to 90-day supply after the third fill.
Note: Due to manufacturer restrictions, a small number of specialty drugs may only be available through a Preferred retail pharmacy. You will be responsible for paying only the copayments shown here for specialty drugs affected by these restrictions.
Contact Us: If you have any questions about this program, or need assistance with your specialty drug orders, please call 888-346-3731, TTY: 711.
Standard Option - You Pay
Tier 4 (preferred specialty drug): $100 copayment for each purchase of up to a 30-day supply ($300 copayment for a 31 to 90-day supply) (no deductible)
Tier 5 (non-preferred specialty drug): $150 copayment for each purchase of up to a 30-day supply ($450 copayment for a 31 to 90-day supply) (no deductible)
Basic Option - You Pay
Tier 4 (preferred specialty drug): 35% of the Plan allowance ($250 maximum) for each purchase of up to a 30-day supply ($700 maximum for a 31 to 90-day supply)
Tier 5 (non-preferred specialty drug): 35% of the Plan allowance ($500 maximum) for each purchase of up to a 30-day supply ($850 maximum for a 31 to 90-day supply)
When Medicare Part B is primary, you pay the following:
Tier 4 (preferred specialty drug): 35% of the Plan allowance ($200 maximum) for each purchase of up to a 30-day supply ($450 maximum for a 31 to 90-day supply)
Tier 5 (non-preferred specialty drug): 35% of the Plan allowance ($450 maximum) for each purchase of up to a 30-day supply ($625 maximum for a 31 to 90-day supply)
Covered Medication and Supplies (cont.)
Specialty Drug Pharmacy Program
We cover specialty drugs that are listed on the Service Benefit Plan Specialty Drug List. This list is subject to change. For the most up-to-date list, call the phone number below or visit our website, www.fepblue.org. (See Section 10 for the definition of "specialty drugs.")
Each time you order a new specialty drug or refill, a Specialty Drug pharmacy representative will work with you. See Section 7 for more details about the Program.
Note: Benefits for the first three fills of each Tier 4 or Tier 5 specialty drug are limited to a 30-day supply. Benefits are available for a 31 to 90-day supply after the third fill.
Note: Due to manufacturer restrictions, a small number of specialty drugs may only be available through a Preferred retail pharmacy. You will be responsible for paying only the copayments shown here for specialty drugs affected by these restrictions.
Contact Us: If you have any questions about this program, or need assistance with your specialty drug orders, please call 888-346-3731, TTY: 711.
Standard Option - You Pay
Tier 4 (preferred specialty drug): $100 copayment for each purchase of up to a 30-day supply ($300 copayment for a 31 to 90-day supply) (no deductible)
Tier 5 (non-preferred specialty drug): $150 copayment for each purchase of up to a 30-day supply ($450 copayment for a 31 to 90-day supply) (no deductible)
Basic Option - You Pay
Tier 4 (preferred specialty drug): 35% of the Plan allowance ($250 maximum) for each purchase of up to a 30-day supply ($700 maximum for a 31 to 90-day supply)
Tier 5 (non-preferred specialty drug): 35% of the Plan allowance ($500 maximum) for each purchase of up to a 30-day supply ($850 maximum for a 31 to 90-day supply)
When Medicare Part B is primary, you pay the following:
Tier 4 (preferred specialty drug): 35% of the Plan allowance ($200 maximum) for each purchase of up to a 30-day supply ($450 maximum for a 31 to 90-day supply)
Tier 5 (non-preferred specialty drug): 35% of the Plan allowance ($450 maximum) for each purchase of up to a 30-day supply ($625 maximum for a 31 to 90-day supply)
Benefit Description
Asthma Medications
Preferred Retail Pharmacies:
Note: See Section 3 for information about drugs and supplies that require prior approval.
Standard Option - You Pay
Tier 1 (generic drug): $5 copayment (no deductible)
Tier 2 (preferred brand-name drug): 20% of the Plan allowance (no deductible)
Tier 2 (preferred controller medication): $35 copayment for each purchase of up to a 30-day supply ($105 copayment for a 31 to 90-day supply)
Basic Option - You Pay
Tier 1 (generic drug): $5 copayment for each purchase of up to a 90-day supply
Tier 2 (preferred brand-name drug): $35 copayment for each purchase of up to a 30-day supply ($105 copayment for a 31 to 90-day supply)
Basic Option - When Medicare Part B is primary, you pay the following:
Tier 1 (generic drug): $5 copayment
Tier 2 (preferred brand-name drug): $30 copayment for each purchase of up to a 30-day supply ($90 copayment for a 31 to 90-day supply)
Asthma Medications
Preferred Retail Pharmacies:
Note: See Section 3 for information about drugs and supplies that require prior approval.
Standard Option - You Pay
Tier 1 (generic drug): $5 copayment (no deductible)
Tier 2 (preferred brand-name drug): 20% of the Plan allowance (no deductible)
Tier 2 (preferred controller medication): $35 copayment for each purchase of up to a 30-day supply ($105 copayment for a 31 to 90-day supply)
Basic Option - You Pay
Tier 1 (generic drug): $5 copayment for each purchase of up to a 90-day supply
Tier 2 (preferred brand-name drug): $35 copayment for each purchase of up to a 30-day supply ($105 copayment for a 31 to 90-day supply)
Basic Option - When Medicare Part B is primary, you pay the following:
Tier 1 (generic drug): $5 copayment
Tier 2 (preferred brand-name drug): $30 copayment for each purchase of up to a 30-day supply ($90 copayment for a 31 to 90-day supply)
Covered Medication and Supplies - continued on next page