Understanding Your BlueMedicare Drug List

Posted on Feb 19th 2019 by Florida Blue

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The best way to avoid surprises at the pharmacy is to know what your plan covers. You can find that information in your plan’s formulary (list of covered drugs). We mail you a new list of covered drugs each year.

Log in to your member account at floridablue.com/medicare to find your drug list. Or find and download your plan's drug list on our Medicare website.

When you open it up and look for a certain drug, you'll see something like this:

 

First column: What's it called?

The first step to finding your prescription in a formulary is knowing its drug name. You can get that information from your prescription, doctor's office or pharmacy.

There are two ways to find your drug within the drug list:

  • Search by Medical Condition
  • Search by Alphabetical Order using the index in the back of your drug list

In your plan’s formulary, you'll notice drug names are either in capital letters or italic type. In general, these mean:

  • lowercase italic = generic drugs that usually have lower copays and costs.
  • ALL CAPITAL LETTERS = brand name drugs that usually have higher copays and costs.

 

Second column: What will you pay?

The second column, drug tier, also gives you important information about cost. What you pay depends on which plan you have. Here's what drug tiers tell you.

  • Tier 1 Preferred Generics: Commonly prescribed generic versions of brand-name drugs with the lowest copay.
  • Tier 2 Generics: Generic drugs with a higher copay that still save you money over the brand name versions.
  • Tier 3 Preferred Brand: Brand-name drugs with a lower copay or cost than drugs in Tier 4.
  • Tier 4 Non-preferred Drugs: Many of these drugs have lower-cost alternatives available in other tiers, so your copay or cost will be higher.
  • Tier 5 Specialty: These drugs require special handling or administration, so they tend to be the most expensive.

Some BlueMedicare plans have Tier 6 Select Care Drugs. These drugs have $0 copay and are commonly prescribed to treat ongoing health conditions like diabetes or high cholesterol.

To find out exactly what your costs will be for a prescription, log in to your member account to quickly find your plan’s Evidence of Coverage. Or, look up your plan's Evidence of Coverage on floridablue.com/medicare.

Third column: What do you need to do to fill your prescription?

The requirements/limits in column three tell you about any special rules for your prescription. They're especially important because if you don't follow them, your plan might not pay its share of the cost.

In the example above, “QL” stands for quantity limits. It tells you that your plan will only pay for 30 packets of medicine every 30 days. Other common letters you'll see in column three include:

  • “ST” = Step therapy, which means trying lower-cost drugs before your plan will pay for more expensive options.
  • “PA” = Prior authorization, which means your plan needs to approve the prescription before you fill it.

You'll find all these abbreviations and what they mean in the Abbreviation Key near the front of your plan’s formulary.

Questions?

Talk to your doctor about your list of covered drugs. If you have concerns about how your drug is covered or what your drug costs, your doctor may be able to help.

You can also call us with any questions you have about how your plan covers your prescription drugs. Call Prime at <1-855-457-0616, 24 hours a day, 7 days a week. TTY users, call 711.>

 

 

 

 


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