Prescription Drugs

Benefit Overview

The Prescription Drug Benefit provides affordable access to commonly used medications through Blue Cross Blue Shield of Michigan (BCBSM). Each WMHIP medical plan includes prescription coverage with low copays for generic and brand-name drugs, plus mail-order options for convenience and savings.

Available to employees enrolled in an Eaton RESA medical plan. Eligible dependents covered under the same medical plan are also included in this benefit.

How It Works

Prescription drug coverage is included with your medical plan through BCBSM. You’ll pay a set copay or coinsurance amount based on your plan and the medication type. Members can fill prescriptions at any in-network retail pharmacy or through the BCBSM mail-order service for up to a 90-day supply.

Prescription Cost Breakdown

Each medical plan includes a unique prescription structure. Review the chart below for details based on your plan selection.

PPO WMHIP Versatile	Retail (30-day supply)	Retail/Mail Order (90-day supply)
Generic Drugs	$10 copay	$20 copay
Brand Drugs	$40 copay	$80 copay
Over-the-Counter (OTC)	$0 copay – includes Zyrtec, Zyrtec D, Prilosec, Claritin, Children’s Claritin, Claritin RediTabs, and Claritin-D	Included at the same copay levels
Out-of-Network	Reimbursed at 75% of the approved amount, less copay	—

PPO WMHIP Select	Retail (30-day supply)	Retail/Mail Order (90-day supply)
Generic Drugs	$10 copay	$20 copay
Brand Drugs	$40 copay	$80 copay
Over-the-Counter (OTC)	$0 copay – includes Zyrtec, Zyrtec D, Prilosec, Claritin, Children’s Claritin, Claritin RediTabs, and Claritin-D	Included at the same copay levels
Out-of-Network	Reimbursed at 75% of the approved amount, less copay	—

PPO WMHIP Flexible Blue	Retail (30-day supply)	Retail/Mail Order (90-day supply)
Generic Drugs	$10 copay after deductible	$40 copay
Brand Drugs	$40 copay after deductible	$80 copay (Preferred)
Over-the-Counter (OTC)	$0 copay after deductible – includes Zyrtec, Zyrtec D, Prilosec, Claritin, Children’s Claritin, Claritin RediTabs, and Claritin-D	Included at the same copay levels
Out-of-Network	Reimbursed at 80% of the approved amount, less copay	—

WMHIP Simply Blue	Retail (30-day supply)	Retail/Mail Order (90-day supply)
Generic Drugs	$20 copay	$40 copay
Preferred Brand Drugs	$40 copay	$80 copay
Non-Preferred Brand Drugs	$80 copay	$160 copay
Out-of-Network	Reimbursed at 75% of the approved amount, less copay	—

Additional Information

Prescriptions filled at out-of-network pharmacies are reimbursed at a reduced amount after copay.
Mail-order service is ideal for maintenance medications and can provide cost savings for 90-day refills.
Preventive medications under the Affordable Care Act may be covered at no cost.
Always present your BCBSM ID card at the pharmacy to ensure correct pricing.

Specialty Medications

Certain high-cost or complex medications are considered specialty drugs and must be filled through BCBSM’s exclusive specialty pharmacy network. Your provider will help determine eligibility and obtain any required prior authorization before you fill your prescription.

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