Primary Choice Pharmacy Benefits
Any questions about your pharmacy benefit can be answered by calling Member Services. Just call the number on the back of your member ID card.
Drug Tiers
| Your Cost | Drug Tier | Usually Includes |
|---|---|---|
| $ | Tier 1 | Lowest-cost prescription generic and some over-the-counter drugs. |
| $$ | Tier 2 | Prescription generic and some over-the-counter drugs. |
| $$$ | Tier 3 | Brand-name drugs that don't have a generic available. Also may include higher priced generics that have more cost-effective options at lower tiers. |
| $$$$ | Tier 4 | Brand-name drugs that have brand or generic options at lower tiers. Also may include higher-priced generics that have more cost-effective options at lower tiers. |
| $$$$$ | Tier 5 | Specialty drugs* that are more cost-effective than other specialty drugs that treat the same conditions. Also may include some non-specialty brand or generic drugs that have more cost-effective options at lower tiers. |
| $$$$$$ | Tier 6 | Specialty drugs that have more cost-effective alternatives at Tier 5. Also, may include some non-specialty brand or generic drugs that have more cost-effective options at lower tiers. |
*Specialty drugs are prescription medications that are used to treat complex or chronic medical conditions, such as cancer, rheumatoid arthritis, multiple sclerosis and hepatitis C.
Please note that if a plan has a brand deductible, any tier 3 or tier 4 medication will process to that deductible before applying benefits.
Vaccines
Where can you get your flu vaccine and other vaccines?
Effective immediately, you can get your seasonal flu vaccine covered at $0 copay through your pharmacy benefit by visiting any network pharmacy. You can also visit your primary care physician. Need to find one?
You can also visit a participating pharmacy within South Carolina or the entire U.S. to get some non-seasonal preventive care vaccines at a $0 copay. A chart of these vaccines is as follows:
| Vaccine | Min. Age | Max. Age |
|---|---|---|
| HAEMOPHILUS B | --- | 6 years |
| HEPATITIS A (INACTIVATED)-HEPATITIS B (RECOMBINANT) VACCINE | --- | --- |
| HEPATITIS A VACCINE | --- | --- |
| HEPATITIS B VACCINE | --- | --- |
| HEPATITIS B VACCINE RECOMB ADJUVANTED PREF SYR 20 MCG/0.5ML | 18 years | --- |
| HUMAN PAPILLOMAVIRUS (HPV)* | 9 years | 45 years |
| MENINGOCOCCAL | --- | --- |
| PNEUMOCOCCAL (Capvaxive Pneumococcal 21-Valent Conjugate Vaccine 0.5mL)^ | 18 years | --- |
| POLIOVIRUS VACCINE, IPV | --- | 17 years |
| RESPIRATORY SYNCYTIAL VIRUS VACCINE [RECOMBINANT] (Abrysvo 120 mcg/0.5 mL) * | --- | --- |
| RESPIRATORY SYNCYTIAL VIRUS VACCINE [RECOMBINANT (ADJUVANTED)] (Arexvy 120 mcg/0.5 mL) * | 50 years | --- |
| RESPIRATORY SYNCYTIAL VIRUS VACCINE (mRESVIA 50 mcg/0.5mL) Ϯ | 60 years | --- |
| ROTAVIRUS VACCINE, LIVE ORAL | --- | 8 months |
| SMALLPOX & MONKEYPOX ≠ (Jynneos 0.5 mL) | 18 years | --- |
| TOXOID COMBINATIONS | --- | --- |
| VARICELLA VIRUS VACCINE LIVE | --- | |
| VIRAL VACCINE COMBINATIONS | --- | --- |
| ZOSTER VAC RECOMBINANT ADJUVANTED FOR IM INJ 50 MCG/0.5ML | 19 years | --- |
*FDA expanded approval; Gardasil now available for use in individuals aged 9 through 45 years. ^FDA approved in June 2024, Capvaxive is indicated for active immunization in adults aged ≥ 18.
¥Abrysvo is the only RSV vaccine approved for use during pregnancy; dose should be received between 32 and 36 weeks.
# As of July 2024, the age indication for Arexvy expanded to ≥ 50 years for individuals at increased risk of severe RSV outcomes.
Ϯ Mresvia is indicated for adults aged ≥ 60 to protect against RSV.
≠Jynneos is for prevention in individuals aged ≥ 18 who are determined to be at high risk for smallpox or monkeypox infection.