Blue Cross and Blue Shield of North Carolina offers three drug formularies so Medicare beneficiaries can have options for their prescription needs. Blue Medicare HMO Enhanced, Blue Medicare PPO Enhanced share the same Medicare prescription drug list. This list is based on a preferred list of FDA-approved prescription drugs and was developed using guidelines from the federal government. The drug list includes many highly utilized generic, some brand name and specialty drugs. This list also includes a lower cost tier for some maintenance medications related to High Blood Pressure, High Cholesterol and Diabetic conditions.
The Blue Medicare HMO Standard, Blue Medicare HMO Essential and Blue Medicare Rx (PDP) Standard Plan Drug Lists is also based on a preferred list of FDA-approved prescription drugs and was developed using guidelines from the federal government. The drug list for this plan has many highly utilized generic drugs, and some brand name and specialty drugs. Many of the most popular generic prescriptions are included. Blue Medicare Rx (PDP) Enhanced prescription drug list is based on a preferred list of FDA-approved prescription drugs and was developed using guidelines from the federal government. The drug list includes more generic, brand name and specialty drugs.
Generic drugs have the same active ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. Certain vaccinations, insulin and insulin injection supplies are also covered on all formularies. Over-the-counter drugs are not covered because they are excluded by Medicare.
To determine if your drugs are covered by Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx, click the button below to search the drug list. Log in or be sure to select your plan when prompted to view the correct formulary information.1
Tips For Using The Drug List
- Prior authorization, step therapy, and quantity limitations - To encourage the appropriate use of prescription drugs, some quantities are limited and some drugs must be approved before they will be covered.
- 60-day notice - If you are affected by a change to the formulary, you will receive written notice regarding the change.
- If you can't find your drug - Your drug may not be covered, if you do not find it on the drug list. To verify
whether a drug is covered, you may call Customer Service toll-free 7 days a week from 8:00 a.m. to 8:00 p.m.
Blue Medicare Rx 1-888-247-4142; TTY/TDD 1-888-247-4145
Blue Medicare HMO 1-888-310-4110; TTY/TDD 1-888-451-9957
Blue Medicare PPO 1-877-494-7647; TTY/TDD 1-888-451-9957
- If your drug is not covered - If Blue Medicare HMO, Blue Medicare PPO or Blue Medicare Rx does not cover your drug, you have the right as a member to request that an exception be made to the formulary or to request a transition supply, while you find an appropriate alternative prescription.
For instructions on how to request a transition supply or an exception to the formulary, and instructions on how to appeal a decision about an exception or to file a grievance if you are dissatisfied for any reason, please review the following documents:
- Transition process
- Coverage determination
- Appeals process
- Grievance procedures
Limitations and exclusions - Like most insurance coverage, our Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx plans have some limitations and exclusions.
For current and future changes to the formulary for Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx, please see our formulary chart.
1 Formulary and pharmacy networks may change at any time. You will receive notice when necessary.
The information on this page is current as of 10/1/2015.
Y0079_7169 CMS Pending