2024 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits
Page 98
Section 5(f). Prescription Drug Benefits
Page 98
Benefits Description
Covered Medications and Supplies (cont.)
Smoking and Tobacco Cessation Medications
Correction, 3/19/2024
If you are a covered member, you may be eligible to obtain specific prescription generic and brand-name smoking and tobacco cessation medications at no charge. Additionally, you may be eligible to obtain over-the-counter (OTC) smoking and tobacco cessation medications, prescribed by your physician, at no charge. These benefits are only available when you use a Preferred retail pharmacy. The Quit Plan is not required for those covered under the FEP Medicare Prescription Drug Program.
Note: There may be age-restrictions based on U.S. FDA guidelines for these medications.
The following medications are covered through this program:
Notes:
You Pay
Preferred retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Covered Medications and Supplies (cont.)
Smoking and Tobacco Cessation Medications
Correction, 3/19/2024
If you are a covered member, you may be eligible to obtain specific prescription generic and brand-name smoking and tobacco cessation medications at no charge. Additionally, you may be eligible to obtain over-the-counter (OTC) smoking and tobacco cessation medications, prescribed by your physician, at no charge. These benefits are only available when you use a Preferred retail pharmacy. The Quit Plan is not required for those covered under the FEP Medicare Prescription Drug Program.
Note: There may be age-restrictions based on U.S. FDA guidelines for these medications.
The following medications are covered through this program:
- Generic medications available by prescription:
- Bupropion ER 150 mg tablet
- Bupropion SR 150 mg tablet
- Varenicline 0.5 mg tablets
- Varenicline 1 mg tablets
- Varenicline starting pack
- Bupropion ER 150 mg tablet
- Brand-name medications available by prescription:
- Nicotrol cartridge inhaler
- Nicotrol NS spray 10 mg/ml
- Nicotrol cartridge inhaler
- Over-the-counter (OTC) medications
Notes:
- To receive benefits for over-the-counter (OTC) smoking and tobacco cessation medications, you must have a physician’s prescription for each OTC medication that must be filled by a pharmacist at a Preferred retail pharmacy.
- Regular prescription drug benefits will apply to purchases of smoking and tobacco cessation medications not meeting these criteria. Benefits are not available for over-the-counter (OTC) smoking and tobacco cessation medications except as described above.
- See Section 5(a) for our coverage of smoking and tobacco cessation treatment, counseling, and classes.
You Pay
Preferred retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Benefits Description
Not covered:
You Pay
All charges
Not covered:
- Drugs and supplies purchased from a Non-preferred pharmacy
- Medical supplies such as dressings and antiseptics
- Drugs and supplies for cosmetic purposes
- Supplies for weight loss
- Drugs for orthodontic care, dental implants, and periodontal disease
- Drugs used in conjunction with non-covered assisted reproductive technology (ART) and assisted insemination procedures
- Drugs used in conjunction with IVF that exceed the covered 3 per year annual cycle limitation described in this section
You Pay
All charges
Covered Medications and Supplies - continued on next page