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

Medication Therapy Management (MTM)

Medication Therapy Management (MTM) is a free 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:

  • If your medications are working like they should.
  • If you’re having any side effects from your medications
  • If there are lower cost medications on your plan’s covered drug list that you could discuss with your provider to see if they might be right for you
  • Locations where you can safely throw away 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
    • Diabetes
    • End-Stage Renal Disease (ESRD)
    • High cholesterol
    • High blood pressure
    • Osteoporosis, and
  • Take seven or more prescriptions, and
  • Have spent $1,094 on medications in the past three months (This amount will increase to $1,174 in 2022.)
  • In 2022, 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. If we see any issues, your prescriber will get a fax or phone call. Your pharmacist or trained provider will 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 C or Part D benefits, copays, coverage, or providers and pharmacies 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:

  • Blank medication list
  • Drug disposal information

Questions? 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. Or give us a call at the number on the back of your Member ID card.