You and your covered dependents automatically receive prescription benefits under the SEG Choice medical plan. You pay negotiated prescription costs in full until your deductible is met, and the amount you pay for prescriptions counts toward meeting your deductible.

  • The SEG Pharmacy provides certain preventive generics for the management of certain chronic conditions at no cost, regardless of your deductible.
  • Over-the-counter medications, even if prescribed by a doctor, are not covered under prescription benefits and do not count toward your deductible.
  SEG Pharmacy In-Network Retail or Mail Order Per Rx Out-of-Pocket Maximum
  Employee pays amount below after deductible is met.
Preventive Generic Medications1 (not subject to deductible) Free
(regardless of deductible)
30% $100 / 31-day
$250 / 90-day
Non-Preventive Generic Medications & Preferred Brand Medication 25% 30% $100 / 31-day
$250 / 90-day
Non-Preferred Brand 50% 50% None
Specialty Medications (31-day supply only) Caremark Specialty Pharmacy2 ONLY 50% $250 / 31-day

1 Specific generic medications included can change from time to time without notice.
2 Caremark is an independent company providing specialty pharmacy services and prescription drug benefits on behalf of BlueCross.

Things to Note

  • 90-day prescriptions are only available at the SEG Pharmacy or through Caremark Mail Order Pharmacy.
  • Out-of-Network benefits are available with 50% coinsurance for generic and preferred-brand only.

Step Therapy

Step Therapy is a prior-authorization program that encourages the use of cost-effective, therapeutically appropriate medications before other, more costly prescription medication options are considered.

Got Questions?

Call the Employee Resource Center 803-217-4444

Common Questions

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BCBSSC contracts with pharmaceutical companies, on our behalf, for the lowest possible pricing. Generic medications are the most cost-effective options for both you and SEG. If you need to take a brand name medication, using a Preferred Brand will save money. Non-Preferred Brands are the most expensive and in almost every case a therapeutic equivalent will be available on the preferred list. Specialty Medications (not available at SEG Pharmacy) have their own category and rules because they are very costly, require close monitoring and are used under special circumstances.

Talk to your physician or call the SEG Pharmacy at (803) 217-9173 or 1-866-769-9039. You may email the pharmacy at You can check online at Caremark Drug Coverage and Cost.

There is a selected group of medications that treat conditions such as diabetes, high blood pressure, high cholesterol, asthma, heart disease, and osteoporosis that have been placed on a list of 2016 Preventive Generic Medication. These medications are available at no cost through the SEG Pharmacy only – even to Choice plan members before they meet their deductible. Coinsurance applies to these medications at retail pharmacies even before meeting the deductible. A generic medication gets on the list once multiple manufacturers produce the drug and the price comes down. The program encourages people to use these highly effective, economical medications whenever possible.
Only 2019 Preventive Generic Medication on the published list are available at no cost to the employee. These drugs treat certain chronic conditions like heart disease, asthma, and diabetes. A complete list of the included preventive drugs can be found on The Edge, or check with the SEG Pharmacy. All other generic drugs are subject to coinsurance of 30% at retail and Caremark mail order and 25% at the SEG Pharmacy after the Choice Plan deductible is met.
The SEG Pharmacy will carry the BCBSSC PREFERRED BRAND DIABETES PRODUCTS including insulin, oral and injectable medications, and testing supplies. Once the deductible is met, preferred brand diabetes products are available at the SEG Pharmacy for 25% co-insurance, and all other retail locations and Caremark Mail Service for 30% coinsurance. Non-preferred brand diabetes products will fall in the non-preferred category with 50% coinsurance. Preventive generic medications are available at the SEG Pharmacy at no cost to the employee.
OTC prescriptions need to be taken to a retail pharmacy as the SEG Pharmacy does not dispense OTC medications. ​​Any medication available over-the-counter, in any strength, is not covered by your prescription benefit. The IRS will allow people to use HSA funds to pay for OTC medications when they have a prescription and it is dispensed by a pharmacist.
​Specialty medications are available with 50% coinsurance exclusively through Caremark Specialty Pharmacy. Specialty medications are not available through the SEG Pharmacy. ​Your maximum out of pocket cost for a specialty medication is $250 for a 31-day supply, after you meet the plan year deductible.
Only two locations will fill 90-day prescriptions for generic or brand name medications: SEG Pharmacy or Caremark Mail Service Prescription Program. All retail pharmacies like Walmart, Walgreens, CVS, Target, etc. are limited to filling 31-day supplies only.
At SEG Pharmacy and retail you can refill a 31-day supply 7 days early. At SEG Pharmacy or Caremark Mail Service Prescription Program you can refill a 90-day prescription 21 days early. Controlled Substances can only be filled up to 2 days early one time during the life of the prescription.

For certain medications or doses your doctor may need to contact Caremark to approve coverage of your prescription under the pharmacy plan. These medications require prior authorization to help ensure they are prescribed appropriately for specific conditions and often to encourage members to try effective, less costly alternatives first.

You or your doctor can check the Caremark Drug Coverage and Cost. Drugs that require prior authorization have a (PA) label next to the drug brand name. Certain medications used to treat heartburn, ulcers, pain, inflammation, certain cardiovascular conditions and many specialty medications require prior authorization. Covered self-injectable drugs available at the SEG Pharmacy include medications that treat diabetes, migraine headaches, anaphylactic reactions, vitamin deficiencies, and certain blood clotting disorders.​

Yes. Almost everything dispensed at the SEG Pharmacy can be dispensed for a 90-day supply if the written prescription allows. Schedule II Controlled Substances cannot be dispensed for 90-days.

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