Legend:
(g) This drug is a generic prescription drug.
(b) This drug is a brand name prescription drug.
(p) This drug requires prior authorization for benefits to be provided.
(d) This is a Disease Specific Drug, which requires prior authorization for benefits to be provided. The benefits associated with Disease Specific Drugs may be different than the standard copay amounts. Details are in your health and wellness benefit plan.
(f) You will pay the total cost of the drug, because generic equivalents are available.
(i) Penalties may apply for the purchase of this brand name drug, because generic equivalents are available.
(3) This drug can be filled three times at a pharmacy. After that it will only be covered if ordered by mail.
(m) This drug is only covered when ordered by mail.
(q) This drug has quantity limits. Click on the drug name to view details.
(a) This drug has an age restriction. Click on the drug name to view details.
(r) As lower cost alternatives are available for this drug, Benefits paid by Blue Cross & Blue Shield of Mississippi will be no greater than the Benefit for the lowest cost alternative. The member will be responsible for the difference between the cost of the lower cost alternative and this drug's price.