Prescription Drug Benefits

The Sapphire, Ruby and Diamond plan options all include the same prescription drug benefits and use the same pharmacy network.

However, the plans’ formulary (drug list) is different:

• Sapphire uses our standard formulary.
• Ruby and Diamond use our expanded formulary.

Both formularies include drugs in all classes covered by Medicare Part D. The expanded formulary covers more drugs than the standard formulary.

To see if your drugs are covered and the copays that apply, please see our formulary (drug list).

*You pay this amount until you and the plan pay a total of $2,830 for covered prescription drug expenses (including drug costs, copayments, coinsurance, and deductibles).

Please note: After your total yearly drug costs reach $2,830 you pay 100% of your drug costs until your yearly out-of-pocket drug costs reach $4,550.

All prescription drugs must be covered by Medicare Part D and the plan’s formulary and must be purchased at a network pharmacy for these cost sharing amounts to apply. For a complete list of benefits, please see the Summary of Benefits (Coming Soon). For detailed information on this plan and its major limitations or exclusion, please review the Evidence of Coverage (Coming Soon). For full information on BlueAdvantage PPO, please contact us.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days a week;
• The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
• Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy-five percent of drug costs including monthly  prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

For full information on BlueCross BlueShield of Tennessee benefits, call our Customer Service Department at 1-866-210-1522, 8 am to 9 pm, Eastern Time, 7 days a week. TTY users should call, 1-877-664-6422. From March 1 to September 30, you may be required to leave a voice mail on weekends and holidays. Calls will be returned within one business day.

BlueCross BlueShield of Tennessee’s Medicare contract is renewed annually. The availability of coverage beyond the end of this contract year is not guaranteed. Benefits, premiums, copays, coinsurance, formulary,pharmacy directory and provider network may change on Jan. 1, 2011.