2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits

Benefits Description

Smoking and Tobacco Cessation Medications

If you are a covered member, you may be eligible to obtain specific prescription generic and brand-name smoking and tobacco cessation medications at no charge. Additionally, you may be eligible to obtain over-the-counter (OTC) smoking and tobacco cessation medications, prescribed by your physician, at no charge. These benefits are only available when you use a Preferred retail pharmacy.

Note: There may be age-restrictions based on U.S. FDA guidelines for these medications.

The following medications are covered through this program:
 

• Generic medications available by prescription:
   
  • Bupropion ER 150 mg tablet
     
  • Bupropion SR 150 mg tablet
     
  • Varenicline 0.5 mg tablets
     
  • Varenicline 1 mg tablets
     
  • Varenicline starting pack
     
• Brand-name medications available by prescription:
   
  •  Nicotrol cartridge inhaler
     
  • Nicotrol NS spray 10 mg/ml
     
• Over-the-counter (OTC) medications

Notes:
 

• To receive benefits for over-the-counter (OTC) smoking and tobacco cessation medications, you must have a physician’s prescription for each OTC medication that must be filled by a pharmacist at a Preferred retail pharmacy.
   
• Regular prescription drug benefits will apply to purchases of smoking and tobacco cessation medications not meeting these criteria. Benefits are not available for over-the-counter (OTC) smoking and tobacco cessation medications except as described above.
   
• See page 55 for our coverage of smoking and tobacco cessation treatment, counseling, and classes.

You Pay
Preferred retail pharmacy: Nothing (no deductible)

Non-preferred retail pharmacy: You pay all charges