A few frequently asked questions about our Preferred Pharmacy Network
How much do I save on prescriptions?
This depends on the base price of the drug, mark-ups from the wholesaler and pharmacist, and the fee charged by the pharmacist to dispense it.
Dispensing fees and mark-ups can vary from pharmacy to pharmacy. Mark-ups can be as low as 2% while others can go as high as 92%; dispensing fees range from $4.49 to $15 per prescription filled. If you’re on multiple medications that get refilled regularly, these costs can really add up.
Our PPN partners offer a maximum dispensing fee of $10 or less, and where possible, can provide a 100-day supply of maintenance drugs to reduce overall dispensing fees.
Why do pharmacies charge dispensing fees?
Dispensing fees cover services such as prescription verification, medication profile reviews to check for interactions, identification and resolution of problems with the prescription, billing to a third party, and patient counselling.
How does pay-direct claiming work?
This convenient option allows your pharmacist to submit your claim directly to Pacific Blue Cross on your behalf, as opposed to you having to pay for the medication and wait for reimbursement.
Eligible claims are subject to plan limits, including a dispensing fee cap, mark-up limits, and annual deductible and co-insurance as applicable. You only pay for the portion not covered by your plan.
And by using your pay direct benefit, your pharmacist can immediately advise you of plan restrictions, such as prior authorization, generic pricing, and day supply limits. Skipping this step may prove costly; all or a portion of your prescription may not be covered by your plan, leaving you unexpectedly out of pocket.
Your card must be enabled for pay-direct claims.
Are there any membership costs or fees?
No. The PPN is included with your Pacific Blue Cross membership.
What if I can’t fill my prescription in the PPN?
If your benefit plan allows you to shop at other pharmacies, you can fill your prescription outside of the PPN. Note that the total cost of your prescriptions (including dispensing fees) may be higher. When you submit a claim, we reimburse the total prescription cost that is covered by your drug plan, and you’re responsible to pay to the pharmacist any amount above the plan’s coverage level.
I live in an area without a PPN pharmacy. Do I have options?
You may be able to fill your prescriptions at the PPN pharmacy closest to you and have them delivered by mail. Ask them for assistance.
Will other pharmacies be added to the network in future?
We are always seeking new ways to help our members and plan sponsors lower their prescription drug costs. We can’t say if or how soon our PPN will grow, but we will keep you updated along the way.
What’s the benefit of using Pharmacy Compass?
This free Pacific Blue Cross look-up tool allows you to compare pill prices and dispensing fees at the pharmacies closest to where you live or work.
How is my plan’s lifetime maximum impacted by drug costs?
Many benefits plans have lifetime limits. Be aware of the lifetime maximum on your plan, particularly if you are on multiple medications or expensive medications for chronic conditions.
Lifetime maximums for drug plans provide a balance between ensuring access to appropriate medications while ensuring sustainability of the plan for all members.
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