Prescription Drug Benefits – Harvard University Student Health Program

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The Student Health Insurance Plan includes coverage for prescription medications, and there is no dollar limit on this benefit.

Prescriptions fall into three tiers that determine your copayment*:

Tier 1: $17 / Mail Order Copayment: $51
Tier 2: $40 / Mail Order Copayment: $120
Tier 3: $55 / Mail Order Copayment: $165
Other: $0 copayment for prescription contraceptive products that are generic or brand name without a generic equivalent. 50 percent coinsurance for Malarone, Mefloquine, Coartem, and Primaquine

*Retail Pharmacy: Copayments for prescriptions purchased at a retail pharmacy are up to a 30-day supply.

Mail-order prescriptions for less than a 90-day supply of your medication will be paying higher costs than filling at a retail pharmacy. When filling up to a 90-day supply of your medication, you will be paying three copayments for your medication. This applies even if the medication is filled for a one- or two-month supply.

Out-of-pocket costs:

Individual out-of-pocket maximum: $1,300
Family out-of-pocket maximum: $2,600

Once you meet the prescription out-of-pocket maximum, you will not be charged a copayment for your prescriptions for the remainder of the plan year.

Notes:

Over-the-counter drugs are not covered by the health plan.
Mail Order: Members will be charged the mail order co-payment even if the days’ supply is less than 90 days.

Look-Up Your Prescription Copayment Estimate

Visit Bluecrossma.com/medication and type in the name of the medication (select Blue Cross Blue Shield of Massachusetts formulary) or
Create a MyBlue account at Bluecrossma.com/my-account and select “Review Benefits.”

Note:
Information provided on the Blue Cross Blue Shield of MA (BCBSMA) website is based on the standard BCBSMA formulary and includes estimates. There may be discrepancies between the information on this website and the Student Health Insurance Plan (SHIP) prescription coverage, as well as any related documents. It’s possible that the documents on the BCBSMA website may not apply to SHIP specifically, as they may be intended for other Blue Cross Blue Shield plans with different benefits. If you have any questions or concerns about estimating medication costs, please reach out for clarification.

Where to Fill Prescriptions

You can fill or refill up to a 60-day supply of most prescriptions at any participating pharmacy in the United States.

To find a participating pharmacy:

Visit the MyBlue App and log into your account. If you do not already have an account, you will need to create one.
Select the “My Medication” tab from the menu or at the bottom of your phone.
Under “Pharmacy Programs”
Click on the pop-up message stating, “You are now leaving the Blue Cross Blue Shield of Massachusetts site.”
You will be redirected to the Pharmacy Programs website.
At the top right of the page, click Pharmacy locator.

You may also fill prescriptions through mail-order delivery.

Learn more about the mail order benefit

If you purchase prescriptions without using your member ID, you may file for reimbursement through CVS Caremark. You will be reimbursed at the allowed amount minus the applicable copayment.

access the prescription claim form

Prescription ID Card

Your Blue Cross Blue Shield (BCBS) ID number is also used to fill prescriptions.

If you need to fill a prescription, you can obtain your BCBS ID information on the student insurance portal.

Learn how to find your BCBSMA member ID

When filling prescriptions, you will need to provide the pharmacist with the following information:

Plan Name: Blue Cross Blue Shield of Massachusetts (BCBSMA)
Policy Number: Same as the medical BCBSMA ID number
Bin: 004336
PCN: ADV
Group: RX22MA

With the MyBlue Member App, you can also find a doctor, review claims, and keep track of your prescriptions.
Download the MyBlue Member App to access your digital medical/prescription member ID card.
Learn more about the MyBlue Member App and review the MyBlue App FAQs.

Requesting an Early Refill Prior to Leaving the Country

If you are traveling abroad and will not be able to refill your medication while traveling, you may be eligible to request a travel override so that you can take the medication with you.

Complete the Prescription Travel Override Worksheet and return it to Member Services with a copy of your travel itinerary (e-tickets or ticket confirmation page) at least 72 hours before you need to pick up your prescription. Your travel itinerary must include departure and return dates.
Contact your ordering physician and request a script for the number of months you need if you do not have enough refills left. All travel override requests are processed based on your last refill date and your travel dates/documentation provided.

Notes

Requests can only be processed within 10 business days of the departure date.
Overrides are only processed for the amount of time you will be abroad, for up to a maximum of six months.
Students are only allowed to fill the amount of medication that our office has authorized. You can be held liable for any costs filled beyond the amount we authorize.
Travel overrides are only processed for members traveling outside of the United States.

Limitations and restrictions may apply to certain medications. Before you request an override, confirm with your pharmacist that the medication you need does not have any restrictions.