BCBSNC has established a transition process for new enrollees whose current drug therapies are not included in the Blue Medicare Rx's formulary. Generally, temporary supplies of noncovered or nonformulary medications are not covered by these plans, but overrides for certain medications can be made during the transition period. The transition medication supply will provide additional time for you to seek a formulary alternative or to complete an exception request.
A temporary supply of certain noncovered or nonformulary medications may be covered during a transition period for particular scenarios including, but not limited to the following:
We have already identified a number of nonformulary drugs that qualify for automatic transition supplies. These drugs are for treating conditions where a break in current drug therapy could have an adverse affect on your health. If you are currently taking one of these drugs, the pharmacy will fill your prescription for a one-time, 30-day supply after your Plan effective date. You will receive notification that you were dispensed a noncovered or nonformulary medication and the process that must be followed by your provider to request authorization for continued coverage.
For residents of long-term care facilities, who are on noncovered medications, we will provide coverage for a temporary "first fill" supply order for at least a 90- to 180-day supply of medication prescribed by the attending physician until an appropriate arrangement can be made between the facility, the attending physician, and the long-term care pharmacy, on behalf of resident.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. Please contact BCBSNC for details.
Blue Cross and Blue Shield of North Carolina is an HMO and PPO plan with a Medicare contract. Blue Cross and Blue Shield of North Carolina is a PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
Limitations, copayments, and restrictions may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium.
If you would like Medicare Advantage or Part D documents in a different language or format, or your coverage has ended and you need proof of coverage or a Certification of Health Insurance Coverage, you can call us 7 days a week, 8a.m. to 8 p.m.
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The information on this page is current as of 10/01/2011.
Y0079_5325 CMS Approved 10192011