MEDICARE PHARMACY

Your Medicare prescription coverage

When you log in to your account, you can check your pharmacy benefits, see medication lists and chat with us about your options.

Log in to BlueAccess
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See if your medications are covered

Here’s a breakdown of the medication lists, tiers and details covered by your plan.

UNDERSTANDING MEDICARE PHARMACY COVERAGE
Let’s help you find

We want you to understand your Medicare pharmacy benefits, which is why we have a selection of forms that might be useful to you.

How do I find a pharmacy in my network?

You can search for pharmacies by network in the Find a Doctor tool. Either search by the pharmacy’s name and check which networks they’re in, or search for ones near you and filter your results by your network. If you log in to BlueAccess first, your search results will automatically list pharmacies in your network. Need more help? Click here to contact us.

What are “preferred” drugs or pharmacies?

Our doctors and pharmacists create a list of preferred drugs to put in our formulary (your list of covered drugs). Our drug list includes preferred generic (Tier 1) and preferred brand name (Tier 2) drugs. Non-preferred brand name (Tier 3) drugs are not part of the preferred drug list, but are covered by your pharmacy benefits, just at a higher cost.

Some plans have a list of “Preferred Pharmacies” that have agreed to keep costs even lower for our members and you’ll save money if you use them instead of a standard one in your network.

What is a specialty pharmacy or drug?

A specialty drug is a prescription drug that is given by injection or infusion, sometimes by you and sometimes in the doctor’s office. You’ll often get the best price for your medicine by getting it from certain specialty pharmacies, even if it’s your doctor or preferred facility doing the procedure.

See all questions

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One-on-one support for your medications

The experienced pharmacists from our partner, Express Scripts® , can personally talk you through things like dosage, refills and side effects. They’re also specially trained to talk to you about how your drugs work with any health conditions you may have. If you’ve got drug coverage, you can call us to sign up.

Need help? Give us a call.


If you want to chat about Medicare (BlueAdvantage), you can call 1-800-831-BLUE (2583). Or if you have questions about Medicaid With Medicare (BlueCare Plus), call 1-800-332-5762. TTY users should call 711.

If you want to chat about Medicare (BlueAdvantage), you can call
1-800-831-BLUE(2583). Or if you have questions about Medicaid With Medicare (BlueCare Plus), call 1-800-332-5762. TTY users should call 711.

A little extra help can go a long way

Prescription coverage is so important, but it can also be a big expense. If you or your loved ones need help paying for your Medicare prescription coverage, you might qualify for Extra Help through Social Security.

See how to apply
MORE ABOUT THE EXTRA HELP PROGRAM
How do I qualify?

You must be enrolled in a Medicare Prescription Drug Plan to get Extra Help. More specifically, you must have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance); You must live in one of the 50 States or the District of Columbia; and You have up to $18,210 in yearly income ($24,690 for a married couple) and up to $14,100 in resources ($28,150 for a married couple).

Note: Your home, one car, burial plot, up to $1,500 for burial expenses if you have put that money aside, furniture and other personal items do not count towards your resources total amount.

You’re automatically qualified for Extra Help if:
you qualify for Medicaid OR belong to a Medicare Savings Program OR get Supplemental Security Income (SSI) benefits.

Additional information and resources

After you apply, Social Security will review your application and send you a letter to let you know if you qualify for Extra Help.

If you qualify, you can choose a Medicare Prescription Drug Plan. If you do not select a plan, the Centers for Medicare & Medicaid Services (CMS) will do it for you. The sooner you join a plan, the sooner you begin receiving benefits.

If you qualify for Extra Help but your plan has not been notified by the Centers for Medicare & Medicaid Services, you can show certain documents to your pharmacy and pay a reduced copay.


Low Income Subsidy (LIS)

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, your monthly premium will be lower than what it would be if you did not get Extra Help from Medicare. The tables below show what your monthly plan premium will be if you qualify for Extra Help. The premiums are for both medical services and prescription drug benefits. These amounts do not include any Medicare Part B premium you may have to pay. Low Income Subsidy Table for Medicare (BlueAdvantage - PPO)Low Income Subsidy Table for Medicare (BlueEssential - HMO SNP)

To determine which region you are in, please refer to the list below.


Medicare (BlueAdvantage - PPO)SM

The Diamond and Ruby service area includes Anderson, Bedford, Benton, Bledsoe, Blount, Bradley, Campbell, Cannon, Carroll, Carter, Cheatham, Chester, Claiborne, Clay, Cocke, Coffee, Crockett, Cumberland, Davidson, Decatur, DeKalb, Dickson, Dyer, Fayette, Fentress, Franklin, Gibson, Giles, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hardeman, Hardin, Hawkins, Haywood, Henderson, Henry, Hickman, Houston, Humphreys, Jackson, Jefferson, Johnson, Knox, Lake, Lauderdale, Lawrence, Lewis, Lincoln, Loudon, Macon, Madison, Marion, Marshall, Maury, McMinn, McNairy, Meigs, Monroe, Montgomery, Moore, Morgan, Obion, Overton, Perry, Pickett, Polk, Putnam, Rhea, Roane, Robertson, Rutherford, Scott, Sequatchie, Sevier, Shelby, Smith, Stewart, Sullivan, Sumner, Tipton, Trousdale, Unicoi, Union, Van Buren, Warren, Washington, Wayne, Weakley, White, Williamson and Wilson counties.

The Sapphire service area includes Anderson, Bledsoe, Blount, Bradley, Campbell, Cannon, Carter, Claiborne, Clay, Cocke, Cumberland, DeKalb, Fentress, Franklin, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hawkins, Jackson, Jefferson, Johnson, Knox, Loudon, Macon, Marion, McMinn, Meigs, Monroe, Morgan, Overton, Pickett, Polk, Putnam, Rhea, Roane, Scott, Sequatchie, Sevier, Smith, Sullivan, Unicoi, Union, Van Buren, Warren, Washington and White counties.

The Garnet service area includes Bedford, Benton, Carroll, Cheatham, Chester, Coffee, Crockett, Davidson, Decatur, Dickson, Dyer, Fayette, Gibson, Giles, Hardeman, Hardin, Haywood, Henderson, Henry, Hickman, Houston, Humphreys, Lake, Lauderdale, Lawrence, Lewis, Lincoln, Madison, Marshall, Maury, McNairy, Montgomery, Moore, Obion, Perry, Robertson, Rutherford, Shelby, Stewart, Sumner, Tipton, Trousdale, Wayne, Weakley, Williamson and Wilson counties.

BlueEssential (HMO SNP)SM

The BlueEssential service area includes Anderson, Blount, Bradley, Carter, Cheatham, Chester, Davidson, Fayette, Grundy, Hamblen, Hamilton, Hawkins, Jefferson, Knox, Loudon, Madison, Marion, Roane, Robertson, Rutherford, Sequatchie, Sevier, Shelby, Sullivan, Sumner, Unicoi, Union, Washington, Williamson, and Wilson counties.

Have more than one prescription? We can help.

When you have multiple prescriptions for certain health conditions, we have pharmacists who are ready to talk to you about your medications, how they work together and how they make you feel.

There's no need to enroll - if you're eligible, we'll send you a letter and get started with a welcome call at a time that works for you.

Questions? You can call CSS Health at 1-877-450-37101-877-450-3710. They’re available Monday through Friday, 8:30 a.m. to 5 p.m. EST.

MORE ABOUT MEDICATION THERAPY MANAGEMENT
How does this help me?

You will get to work one-on-one with a highly-trained pharmacist. It all starts with a welcome call connecting you to a pharmacist who will:

  • Walk you through the medicines you’re taking.
  • Help you understand how they work together – and the best way to take them.
  • Look for lower-cost options to help you budget for your medications.

Your team will reach out to you periodically to see how you’re doing and to continue helping you manage your medications.

How do I join this program?

There are a few ways you may become part of the Medical Management Therapy program. We’ll reach out when you’re eligible, but you can always contact us if you have any questions.

This program is for Medicare Advantage (BlueAdvantage) or Medicaid With Medicare (BlueCare Plus) members living with three or more ongoing health issues, including:

  • Asthma
  • Chronic Heart Failure (CHF)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Depression
  • Diabetes
  • End-Stage Renal Disease (ESRD)
  • High cholesterol
  • High blood pressure
  • Osteoporosis

You may also be eligible if:

  • You take seven or more medications covered by Medicare Part D.
  • You spent $1,063.75 or more in the previous three months on medications covered by Medicare Part D.

If you’re a Medicare Supplement (BlueEssential) member, you may be eligible if:

  • You have two or more ongoing health problems.
  • You take two or more medications to treat your health conditions.
  • You spent $1,063.75 or more in the previous three months on medications covered by Medicare Part D.