2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits
Page 95
Section 5(f). Prescription Drug Benefits
Page 95
Benefits Description
Covered Medications and Supplies (cont.)
Note: We waive your cost-share for generic contraceptives and for brand-name contraceptives that have no generic equivalent or generic alternative, when you purchase them at a Preferred retail pharmacy.
You Pay
See pages 93 and 98
Covered Medications and Supplies (cont.)
- Drugs to aid smoking and tobacco cessation that require a prescription by federal law
Notes:
- Drugs for the diagnosis of infertility, except as described on page 99
- Drugs to treat gender dysphoria (gonadotropin-releasing hormone (GnRH) antagonists and testosterones)
- Contraceptive drugs and devices, limited to:
- Diaphragms and contraceptive rings
- Injectable contraceptives
- Intrauterine devices (IUDs)
- Implantable contraceptives
- Oral and transdermal contraceptives
- Diaphragms and contraceptive rings
Note: We waive your cost-share for generic contraceptives and for brand-name contraceptives that have no generic equivalent or generic alternative, when you purchase them at a Preferred retail pharmacy.
You Pay
See pages 93 and 98
Benefits Description
Over-the-counter (OTC) contraceptive drugs and devices, limited to:
Note: We provide benefits in full for OTC contraceptive drugs and devices when the contraceptives meet U.S FDA standards for OTC products. To receive benefits, you must use a Preferred retail pharmacy and present the pharmacist with a written prescription from your physician.
You Pay
Preferred retail and overseas retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Note: See Section 5(i), page 108, for information on how to file claims for overseas services.
Over-the-counter (OTC) contraceptive drugs and devices, limited to:
- Emergency contraceptive pills
- Condoms
- Spermicides
- Sponges
Note: We provide benefits in full for OTC contraceptive drugs and devices when the contraceptives meet U.S FDA standards for OTC products. To receive benefits, you must use a Preferred retail pharmacy and present the pharmacist with a written prescription from your physician.
You Pay
Preferred retail and overseas retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Note: See Section 5(i), page 108, for information on how to file claims for overseas services.
Benefits Description
Immunizations when provided by a Preferred retail pharmacy that participates in our vaccine network (see below) and administered in compliance with applicable state law and pharmacy certification requirements. See pages 42 and 44 for specific coverage.
Note: Our vaccine network is a network of Preferred retail pharmacies that have agreements with us to administer one or more routine immunizations. Check with your pharmacy or call our Retail Pharmacy Program at 800-624-5060, TTY: 711, to find out which vaccines your pharmacy can provide.
You Pay
Preferred retail and overseas retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Notes:
Immunizations when provided by a Preferred retail pharmacy that participates in our vaccine network (see below) and administered in compliance with applicable state law and pharmacy certification requirements. See pages 42 and 44 for specific coverage.
Note: Our vaccine network is a network of Preferred retail pharmacies that have agreements with us to administer one or more routine immunizations. Check with your pharmacy or call our Retail Pharmacy Program at 800-624-5060, TTY: 711, to find out which vaccines your pharmacy can provide.
You Pay
Preferred retail and overseas retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Notes:
- You pay nothing for influenza (flu) vaccines obtained at Non-preferred retail pharmacies.
- See Section 5(i), page 108, for information on how to file claims for overseas services.
Covered Medications and Supplies - continued on next page