Drug and Pharmacy Information


Blue Cross Medicare Advantage Pharmacy Directory.pdf
  This directory includes all available network pharmacies, including preferred pharmacies that may help you save on your prescription costs.
Pharmacy Directory.pdf (en español)

Blue Cross MedicareRx Pharmacy Directory.pdf
  This directory includes all available network pharmacies, including preferred pharmacies that may help you save on your prescription costs.
Pharmacy Directory.pdf (en español)

Transition Period Drug Benefit.pdf
Transition Period Drug Benefit.pdf (en español)
Medication Therapy Management Program (MTMP).pdf
Medication Therapy Management Personal Medication List SAMPLE.pdf

Blue Cross Medicare Advantage (HMO)SM

Prescription drug coverage is built in to Blue Cross Medicare AdvantageSM. View our drug list, or formulary below to see if your prescriptions are covered.

Comprehensive Formulary.pdf
Comprehensive Formulary.pdf (en español)
Prior Authorization Instructions and Form(s)
Prior Authorization Criteria.pdf
Quantity Limits Instructions and Form(s)
Step Therapy Instructions and Form(s)
Step Therapy Criteria.pdf
Evidence of Coverage.pdf
  See Chapter 9 for What to do if you have a problem or complaint (coverage decisions, appeals, complaints).
Preferred Pharmacy Directory & Factsheet
  This directory includes information on the preferred pharmacies in your area.

Blue Cross Medicare Advantage (HMO-POS)SM

Prescription drug coverage is built in to Blue Cross Medicare AdvantageSM. View our drug list, or formulary below to see if your prescriptions are covered

Comprehensive Formulary.pdf
Comprehensive Formulary.pdf (en español)
Prior Authorization Instructions and Form(s)
Prior Authorization Criteria.pdf
Quantity Limits Instructions and Form(s)
Step Therapy Instructions and Form(s)
Step Therapy Criteria.pdf
Evidence of Coverage.pdf
  See Chapter 9 for What to do if you have a problem or complaint (coverage decisions, appeals, complaints).
Preferred Pharmacy Directory & Factsheet
  This directory includes information on the preferred pharmacies in your area.

Blue Cross MedicareRx (PDP)SM

Blue Cross MedicareRx offers three plan designs, Basic, Value and Plus. To compare the plans to determine which best meets your needs, use the Plan Selector Tool.

Blue Cross MedicareRx Basic (PDP)SM

Comprehensive Formulary.pdf
Comprehensive Formulary.pdf (en español)
Prior Authorization Instructions and Form(s)
Prior Authorization Criteria.pdf
Quantity Limits Instructions and Form(s)
Step Therapy Instructions and Form(s)
Step Therapy Criteria.pdf
Evidence of Coverage.pdf
Preferred Pharmacy Directory & Factsheet
  This directory includes information on the preferred pharmacies in your area.

Blue Cross MedicareRx Value (PDP)SM

Comprehensive Formulary.pdf
Comprehensive Formulary.pdf (en español)
Prior Authorization Instructions and Form(s)
Prior Authorization Criteria.pdf
Quantity Limits Instructions and Form(s)
Step Therapy Instructions and Form(s)
Step Therapy Criteria.pdf
Evidence of Coverage.pdf
Preferred Pharmacy Directory & Factsheet
  This directory includes information on the preferred pharmacies in your area.

Blue Cross MedicareRx Plus (PDP)SM

Comprehensive Formulary.pdf
Comprehensive Formulary.pdf (en español)
Prior Authorization Instructions and Form(s)
Prior Authorization Criteria.pdf
Quantity Limits Instructions and Form(s)
Step Therapy Instructions and Form(s)
Step Therapy Criteria.pdf
Evidence of Coverage.pdf
Preferred Pharmacy Directory & Factsheet
  This directory includes information on the preferred pharmacies in your area.

Disclaimers:

Blue Cross Medicare Advantage and Blue Cross MedicareRx cover both brand name drugs and generic 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. Learn more about generic drugs.

Our formulary contains drugs defined by CMS as Limited Distribution Drugs. This means the distribution of the drug is limited either by the FDA or drug manufacturer. To see which drugs are Limited Distribution Drugs, see your formulary publication.

The benefit information provided is a brief summary, not a complete description of benefits. Limitations, copayments and restrictions may apply. This is not a complete list of all formulary alternatives covered by the Part D plan for the drug you have selected. For more information contact the plan.

Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.

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Blue Cross Medicare Advantage

This information is available for free in other languages. Please call our Customer Service number at 1-877-774-8592 (TTY/TDD users should call 711).

We are open between 8 a.m. and 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

Esta información está disponible en otros idiomas de forma gratuita. Comuníquese a nuestro número de Servicio al cliente al 1-877-774-8592 (los usuarios de TTY/TDD deben llamar al 711). Nuestro horario es de 8 a.m. a 8 p.m., hora local, los 7 días de la semana. Sí usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y feriados, se usarán tecnologías alternas (por ejemplo, correo de voz).

Contact us at:
Blue Cross Medicare Advantage
P.O. Box 4555
Scranton, PA 18505

Plans available in Cook, DuPage, Kane and Will counties.

Blue Cross Medicare Advantage plans are HMO and HMO-POS plans provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC’s plans depends on contract renewal.

Blue Cross MedicareRx

This information is available for free in other languages. Please call our Customer Service number at 1-888-285-2249 (TTY/TDD users should call 711).

We are open between 8 a.m. and 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

Esta información está disponible en otros idiomas de forma gratuita. Comuníquese a nuestro número de Servicio al cliente al 1-888-285-2249 (los usuarios de TTY/TDD deben llamar al 711). Nuestro horario es de 8 a.m. a 8 p.m., hora local, los 7 días de la semana. Sí usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y feriados, se usarán tecnologías alternas (por ejemplo, correo de voz).

Contact us at:
Blue Cross MedicareRx
P.O. Box 3897
Scranton, PA 18505-0897

MyPrime is a pharmacy benefit website owned and operated by Prime Therapeutics LLC, an independent company providing pharmacy benefit management services.

SM Service Mark of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

® Registered Service Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans

Blue Cross MedicareRx is a prescription drug plan provided by HCSC Insurance Services Company (HISC), an independent licensee of the Blue Cross and Blue Shield Association. A Medicare-approved Part D sponsor. Enrollment in HISC's plan depends on contract renewal.

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