2024 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits
Drugs From Other Sources
Section 5(f). Prescription Drug Benefits
Drugs From Other Sources
Benefits Description
Drugs From Other Sources
Covered prescription drugs and supplies not obtained at a retail pharmacy or through the Specialty Drug Pharmacy Program to include, but not limited to:
Note: Prior approval is required for certain high-cost drugs obtained outside one of our pharmacy programs. Contact the customer service number on the back of your ID card or visit us at www.fepblue.org/highcostdrugs for a list of these drugs. See Section 3 for more information on prior approval.
You Pay
Preferred professional providers and facilities: 30% of the Plan allowance (deductible applies)
Non-preferred professional providers (Participating/Non-participating) and Non-preferred facilities (Member/Non-member): You pay all charges
Drugs From Other Sources
Covered prescription drugs and supplies not obtained at a retail pharmacy or through the Specialty Drug Pharmacy Program to include, but not limited to:
- Physician’s office – for more information refer to Section 5(a)
- Facility (inpatient or outpatient) – for more information refer to Section 5(c)
- Hospice agency – for more information refer to Section 5(c)
- Drugs obtained at a physician’s office, inpatient or outpatient facility or hospice agency while overseas, see Section 5(i)
- Drugs and supplies covered only under the medical benefit, see auto-immune infusions below
- Prescription drugs obtained from a Preferred retail pharmacy, that are billed by a skilled nursing facility, nursing home, or extended care facility previously described in this section
Note: Prior approval is required for certain high-cost drugs obtained outside one of our pharmacy programs. Contact the customer service number on the back of your ID card or visit us at www.fepblue.org/highcostdrugs for a list of these drugs. See Section 3 for more information on prior approval.
You Pay
Preferred professional providers and facilities: 30% of the Plan allowance (deductible applies)
Non-preferred professional providers (Participating/Non-participating) and Non-preferred facilities (Member/Non-member): You pay all charges
Benefits Description
For members covered under our traditional pharmacy drug program
Auto-immune infusion medications: Remicade, Renflexis and Inflectra
Notes:
You Pay
Preferred professional providers and facilities: 30% of the Plan allowance (deductible applies)
Non-preferred professional providers (Participating/Non-participating) and Non-preferred facilities (Member/Non-member): You pay all charges
For members covered under our traditional pharmacy drug program
Auto-immune infusion medications: Remicade, Renflexis and Inflectra
Notes:
- Benefits for certain auto-immune infusion medications (limited to Remicade, Renflexis and Inflectra) are covered only when they are obtained by a non-pharmacy provider, such as a physician or facility (hospital or ambulatory surgical center).
- Members covered under the FEP Medicare Prescription Drug Program may obtain these drugs under their pharmacy benefits.
You Pay
Preferred professional providers and facilities: 30% of the Plan allowance (deductible applies)
Non-preferred professional providers (Participating/Non-participating) and Non-preferred facilities (Member/Non-member): You pay all charges