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 plan's 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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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 if you're eligible and how to apply

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 Medication Therapy Management 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 Medicare with Medicaid (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 Advantage (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.