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.

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See if your medications are covered

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

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See pharmacies in your area

We can help you find a pharmacy that's near you and in your network.

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 Care 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 your account 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). For most plans, this list is divided into tiers, ranging from lowest cost-share to highest-cost share. You save money when you use lower tier drugs.  

The tiers are:

  • Tier 1 - Preferred Generic Drugs (lowest cost-share)
  • Tier 2 - Generic Drugs
  • Tier 3 - Select Insulin and Preferred Brand Drugs
  • Tier 4 - Non-Preferred Drugs
  • Tier 5 - Specialty Drugs (highest cost-share)

Some plans have a list of “Preferred Pharmacies” that have agreed to keep costs even lower for our members. You’ll save money if you use them.

 

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
What qualifies you for Extra Help?

  • You have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance)
  • You live in the United States
  • You meet the income and resource limit

What are the income and resource limits?

  • Your income is how much money you make each year.
  • Your resources are things of value that you own, like real estate, bank accounts and investments. Go to Medicare.gov for details on what counts in resources limits.

The income limit is based on your income from the previous year.

This page will be updated with 2024 information as soon as it is available. The income and resource limits for 2023 were:

Your Status Income Limit Resource Limit
Single $21,870 $16,600
Married couple living together $29,580 $33,240

What are the benefits?

Starting in 2024, all Extra Help beneficiaries will receive full benefits.

Full benefits

  • No monthly premium
  • No deductible
  • Up to $4.50 for each generic drug
  • Up to $11.20 for each brand name drug

Once your total drug costs (what both you and your plan pay) reach $8000, you’ll pay $0 for each covered drug.

How do I apply for Extra Help?

There are three ways to apply.

  1. Apply online at Social Security.
  2. Apply over the phone by calling Social Security at 1-800-772-1213 ,TTY 1-800-325-07781-800-772-1213, TTY 1-800-325-0778. Available in most U.S. time zones Monday – Friday 8 a.m. – 7 p.m. in English and other languages.
  3. Apply in person at your local Social Security Office.

After you apply, Social Security will review your application and send you a letter to let you know if you qualify for Extra Help. And, if you do, you can choose a Medicare Advantage Prescription Drug Plan. If you don't 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 hasn't been notified by CMS, you can show certain documents to your pharmacy and pay a lower copay.

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Medication Therapy Management (MTM)

Medication Therapy Management (MTM) is a program we offer eligible Medicare Advantage Prescription Drug plan members. It’s intended to help improve medication use, lower the risk of medication interactions and help members take medications as prescribed. The program includes a one-on-one consultation with a pharmacist or other qualified provider to review your prescription and over-the-counter medications. This is called a comprehensive medication review (CMR). It’s designed just for you and usually takes around 15-20 minutes. At the end of the review, you’ll get a copy of your list of medications and any topics you discussed.

During your personalized review, the pharmacist or other qualified provider will talk with you about:

  • Whether your medications are working like they should
  • Whether you’re having any side effects from your medications
  • Whether there are lower cost medications on your plan’s covered drug list that you could discuss with your prescriber to see if they might be right for you
  • Locations where you can safely throw away unused medications

MORE ABOUT MEDICATION THERAPY MANAGEMENT
Who’s eligible for this program?

To be eligible, you must:

  • Have three or more of these ongoing or chronic health issues:
    • Asthma
    • Chronic Heart Failure (CHF)
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Depression
    • End-Stage Renal Disease (ESRD)
    • High cholesterol
  • Take eight or more prescriptions, and
  • Have spent $1,332.50 on medications in the past three months

Members in the Drug Management Program will be automatically enrolled.

What do I need to do to enroll?

You don’t have to do anything. You’ll be automatically enrolled if you’re eligible. We’ll send you a letter to notify you. Once you’re enrolled, you’ll get the yearly comprehensive medication review, which includes an updated medication list and safe drug disposal tips. You’ll also get quarterly targeted medication reviews (TMRs) that look for changes in the drugs you take that might need to be addressed with your prescriber. We’ll send your prescriber a fax with suggested changes if necessary. Your MTM pharmacist or other qualified provider will also follow up with you, if needed.

You don’t have to participate in the MTM program if you don’t want to, and the MTM program doesn’t impact your plan Part D benefits, copays, coverage, or providers and pharmacies that may be in your plan’s network. You can decline certain parts of the MTM program and still stay enrolled, too.

Here are some of the resources to help you prepare for your comprehensive medication review:

PDF Icon | BCBS of TennesseeBlank medication List

PDF Icon | BCBS of TennesseeDrug Disposal Information

Questions? Call CSS Health at 1-877-450-3710 ,TTY 7111-877-450-3710, TTY 711. They’re available Monday through Friday, 8:30 a.m. to 5 p.m. EST. Or give us a call at the number on the back of your Member ID card.