Zero-Dollar Emergency-Use Medications
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Defines a list of select acute, life‑saving medications provided with a $0 member cost share for emergency or life‑saving use, and explains availability through in‑network pharmacies for eligible pharmacy benefits.
No material clinical or coverage changes in this revision.
Zero-dollar Emergency-use Medication Coverage
Zero-dollar emergency-use medication coverage
Covered when provided for emergency or life‑saving use and when plan terms allow.
See member benefit materials for plan limits and network participation. Coverage is subject to the terms and limits of the member's benefit plan.
List of zero-dollar emergency-use medicines is subject to change.
The $0 member cost share for listed emergency‑use, life‑saving medications does not apply to health savings account (HSA) plans. In addition, not all plan benefits may include this coverage; availability depends on the member's specific benefit plan and any plan renewal provisions.
Provider Responsibilities and Authorization
No prior authorization specified
The policy does not list any prior authorization requirements for the zero-dollar emergency‑use medications; coverage remains subject to the member's benefit plan terms and limits.
No step therapy rules
This document does not specify any step therapy requirements for the listed zero‑dollar emergency‑use medications.
Confirm plan‑specific coverage and network
Check the member's benefit materials or call the number on the member ID card for plan‑specific coverage, network details, and limits; in‑network pharmacy information is available via Blue Access for Members or myprime.com.
- Use Blue Access for Members at bcbsmt.com or the BCBSMT App to find in‑network pharmacies.
- MyPrime.com provides pharmacy benefit details through Prime Therapeutics LLC.
Coverage subject to plan terms and exclusions
Coverage of the listed medications at a $0 cost share is subject to the terms and limits of the member's benefit plan; the $0 cost share does not apply to Health Savings Account (HSA) plans and not all plans include this coverage.
- Select plans will have this benefit applied upon plan renewal in 2025 or 2026.
- Treatment decisions remain between the member and their health care provider.
Where the Medications Are Available
Available at in-network pharmacies via Prime Therapeutics
Members with pharmacy benefits administered through Prime Therapeutics LLC can obtain these medications at any in-network pharmacy.
- Includes both value and non-value pharmacies for plans on the Montana Value Network.
- To find an in-network pharmacy, use Blue Access for Members (bcbsmt.com) or myprime.com.
Policy Purpose
This policy is intended to remove cost barriers so members can immediately access select acute medications used in emergency or life‑saving situations (for example, severe allergic reactions, severe hypoglycemia, opioid overdose, and acute anginal episodes). Coverage is limited to the medications listed and is governed by the member's pharmacy benefits and the terms and limits of the benefit plan.
Key Terms
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.