2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 2. Changes for 2026
Page 17

 

  • Your cost share for outpatient drugs, medical devices, and durable medical equipment billed for by a Preferred facility is now 35% of the Plan allowance. (See page 84.)
     
  • Your cost-share for outpatient hospital emergency room services and supplies, including professional provider services, diagnostic studies, radiology services, laboratory tests, and pathology services, when billed by the hospital is now a $425 per day per facility copayment. (See page 93.)
     
  • There is no longer a reduced Tier 1 (generic drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B as primary. You will pay the same cost-share as those who are enrolled in our regular prescription drug program that do not have Medicare Part B primary when purchased from a Preferred retail pharmacy. (See page 105.)
     
  • For members enrolled in our regular pharmacy drug program, your responsibility for a Tier 2 (preferred brand-name drug) is now 35% of the Plan allowance up to a maximum of $150 for purchases up to a 30-day supply and $450 for purchases 31-90 days. (See page 105.)
     
  • There is no longer a reduced Tier 2 (preferred brand name drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B as primary. You will pay the same cost-share as those who are enrolled in our regular prescription drug program that do not have Medicare Part B primary when purchased from a Preferred retail pharmacy. (See page 105.)
     
  • There is no longer a separate Mail Order Prescription Drug Program Tier 1 (generic drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B primary.
     
  • There is no longer a separate Mail Order Prescription Drug Program Tier 2 (preferred brand-name drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B primary.
     
  • There is no longer a separate Mail Order Prescription Drug Program Tier 3 (non-preferred brand-name drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B primary.
     
  • There is no longer a reduced retail Tier 3 (non-preferred brand name drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B as primary. You will pay the same cost-share as those who are enrolled in our regular prescription drug program that do not have Medicare Part B primary when purchased from a Preferred retail pharmacy. (See page 105).
     
  • For members enrolled in our regular pharmacy drug program, your responsibility for a Tier 4 (preferred specialty drug) obtained from a Preferred retail pharmacy is now 35% of the Plan allowance for a purchase of up to a 30-day supply up to a maximum of $400. (See page 105.)
     
  • There is no longer a reduced Tier 4 (preferred specialty drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B as primary. You will pay the same cost-share as those who are enrolled in our regular prescription drug program that do not have Medicare Part B primary. (See page 105.)
     
  • Under the Specialty Drug Pharmacy Program, your responsibility for a Tier 4 (preferred specialty drug) obtained from the Specialty Drug Pharmacy Program is now 35% of the Plan allowance for a purchase of up to 30-day supply (up to a maximum of $400) and 31 to 90-day supply (up to a maximum of $1,200). (See page 108.)
     
  • There is no longer a reduced Tier 4 (preferred specialty drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B as primary when obtained through the Specialty Drug Pharmacy Program. You will pay the same cost-share as those who are enrolled in our regular prescription drug program that do not have Medicare Part B primary. (See page 108.)
     
  • For members enrolled in our regular pharmacy drug program, your responsibility for a Tier 5 (non-preferred specialty drug) obtained at a Preferred Retail Pharmacy is now 35% of the Plan allowance (up to a maximum of $500) limited to one purchase of up to a 30-day supply. (See page 105.)
     
  • There is no longer a reduced Tier 5 (non-preferred specialty drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B as primary when obtained at a Preferred retail pharmacy. You will pay the same cost-share as those who are enrolled in our regular prescription drug program that do not have Medicare Part B primary. (See page 105.)
     
  • For members enrolled in our regular pharmacy drug program, your responsibility for a Tier 5 (non-preferred specialty drug) obtained through the Specialty Drug Pharmacy Program is now 35% of the Plan allowance for a 30-day supply (up to a maximum of $500) and a 31 to 90-day supply (up to a maximum of $1,500) when purchased through the Specialty Drug Pharmacy Program. (See page 108.)