2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits
Page 96
Section 5(f). Prescription Drug Benefits
Page 96
Benefits Description
Covered Medications and Supplies (cont.)
Diabetic Meter Program
Members with diabetes may obtain one glucose meter kit every 365 days at no cost through our Diabetic Meter Program. To use this program, you must call the phone number listed below and request one of the eligible types of meters. The types of glucose meter kits available through our program are subject to change.
To order your free glucose meter kit, call us toll-free at 855-582-2024, Monday through Friday, from 9 a.m. to 7 p.m., Eastern Time, or visit our website at www.fepblue.org. The selected meter kit will be sent to you within 7 to 10 days of your request.
Note: Contact your physician to obtain a new prescription for the test strips and lancets to use with the new meter. Benefits will be provided for the test strips at Tier 2 (preferred brand-name) benefit payment levels if you purchase brand-name strips at a Preferred retail pharmacy. See page 97 for more information.
You Pay
Nothing for a glucose meter kit ordered through our Diabetic Meter Program
When obtained from any other source: You pay all charges
Covered Medications and Supplies (cont.)
Diabetic Meter Program
Members with diabetes may obtain one glucose meter kit every 365 days at no cost through our Diabetic Meter Program. To use this program, you must call the phone number listed below and request one of the eligible types of meters. The types of glucose meter kits available through our program are subject to change.
To order your free glucose meter kit, call us toll-free at 855-582-2024, Monday through Friday, from 9 a.m. to 7 p.m., Eastern Time, or visit our website at www.fepblue.org. The selected meter kit will be sent to you within 7 to 10 days of your request.
Note: Contact your physician to obtain a new prescription for the test strips and lancets to use with the new meter. Benefits will be provided for the test strips at Tier 2 (preferred brand-name) benefit payment levels if you purchase brand-name strips at a Preferred retail pharmacy. See page 97 for more information.
You Pay
Nothing for a glucose meter kit ordered through our Diabetic Meter Program
When obtained from any other source: You pay all charges
Benefits Description
Medications to promote better health as recommended under the Patient Protection and Affordable Care Act (the “Affordable Care Act”), limited to:
Notes:
You Pay
Preferred retail and overseas retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Note: See Section 5(i), page 108, for information on how to file claims for overseas services.
Medications to promote better health as recommended under the Patient Protection and Affordable Care Act (the “Affordable Care Act”), limited to:
- Iron supplements for children from age 6 months through 12 months
- Oral fluoride supplements for children from age 6 months through 5 years
- Folic acid supplements, 0.4 mg to 0.8 mg, for individuals capable of pregnancy
- Low-dose aspirin (81 mg per day) for pregnant members at risk for preeclampsia
- Aspirin for men age 45 through 79 and women age 50 through 79
- Generic cholesterol-lowering statin drugs
Notes:
- Benefits are not available for acetaminophen, ibuprofen, naproxen, etc.
- Benefits for the medications listed above are subject to the dispensing limitations described on pages 91-92 and are limited to recommended prescribed limits.
- To receive benefits, you must use a Preferred retail pharmacy and present a written prescription from your physician to the pharmacist.
- A complete list of USPSTF-recommended preventive care services is available online at: www.healthcare.gov/preventive-care-benefits. See pages 41-45 and 75 in Section 5(a) and 5(c) for information about other covered preventive care services.
- See page 98 for our coverage of smoking and tobacco cessation medications.
You Pay
Preferred retail and overseas retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Note: See Section 5(i), page 108, for information on how to file claims for overseas services.
Benefits Description
Generic medications to reduce breast cancer risk for women, age 35 or over, who have not been diagnosed with any form of breast cancer
Note: Your physician must send a completed Coverage Request Form to CVS Caremark before you fill the prescription. Call CVS Caremark at 800-624-5060, TTY: 711, to request this form. You can also obtain the Coverage Request Form through our website at www.fepblue.org.
You Pay
Preferred retail and overseas retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Generic medications to reduce breast cancer risk for women, age 35 or over, who have not been diagnosed with any form of breast cancer
Note: Your physician must send a completed Coverage Request Form to CVS Caremark before you fill the prescription. Call CVS Caremark at 800-624-5060, TTY: 711, to request this form. You can also obtain the Coverage Request Form through our website at www.fepblue.org.
You Pay
Preferred retail and overseas retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Covered Medications and Supplies - continued on next page