Section 5(f). Prescription Drug Benefits

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Table of Contents

Introduction/Plain Language/Advisory

5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals

5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals

5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services

5(d). Emergency Services/Accidents

5(e). Mental Health and Substance Use Disorder Benefits

5(f). Prescription Drug Benefits

5(g). Dental Benefits

5(h). Wellness and Other Special Features

5(i). Services, Drugs, and Supplies Provided Overseas

Non-FEHB Benefits Available to Plan Members

Summary of Benefits – Standard Option

Summary of Benefits – Basic Option

2024 Rate Information

Entire brochure in page-number order

Blue Cross and Blue Shield Service Benefit Plan Brochure - 2024

Standard and Basic Options

Section 5(f). Prescription Drug Benefits

Section 5(f). Overview

There are important features you should be aware of

Who can write your prescriptions

Where you can obtain them

What is covered

Generic equivalents

Disclosure of information

These are the dispensing limitations

Patient Safety and Quality Monitoring (PSQM)

Standard Option Generic Incentive Program

Here is how to obtain your prescription drugs and supplies

Preferred Retail Pharmacies

Non-preferred Retail Pharmacies

Mail Service Prescription Drug Program

Specialty Drug Pharmacy Program

Asthma Medications

Other Preferred Diabetic Medications, Test Strips, and Supplies

Diabetic Meter Program

Section 5(f). MPDP Overview

MPDP There are important features you should be aware of

MPDP Who can write your prescriptions

MPDP Where you can obtain them

MPDP What is covered

MPDP Generic equivalents

MPDP Disclosure of information

MPDP These are the dispensing limitations

MPDP Important Contact Information

MPDP Prior Approval

MPDP Medical Foods

MPDP Here is how to obtain your prescription drugs and supplies

MPDP Catastrophic Maximums

MPDP Retail Pharmacies

MPDP Mail Service Prescription Drug Program

MPDP Asthma Medications

MPDP Other Preferred Diabetic Medications, Test Strips, and Supplies

Smoking and Tobacco Cessation Medications

Anti-hypertensive Medications

Over-the-counter (OTC) contraceptive drugs and devices

Immunizations when provided by a Preferred retail pharmacy that participates in our vaccine network

Metformin and metformin extended release (excluding osmotic and modified release generic drugs)

Medications to promote better health as recommended under the ACA

Generic medications to reduce breast cancer risk for women

Bowel preparation medications and antiretroviral therapy medications for HIV

Opioid Reversal Agents: Tier 1 medications limited to generic naloxone spray and injectable

Drugs From Other Sources

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