2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits
Page 100
 
Benefits Description

Covered Medications and Supplies (cont.)

Smoking, Tobacco, and E-Cigarette Cessation Medications


If you are a covered member, you may be eligible to obtain specific prescription generic and brand-name smoking, tobacco, and E-cigarette cessation medications at no charge. Additionally, you may be eligible to obtain over-the-counter (OTC) smoking, tobacco, and E-cigarette cessation medications, prescribed by your physician, at no charge. These benefits are only available when you use a Preferred retail pharmacy.

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
       
  • Brand-name medications available by prescription:
     
    • Chantix 0.5 mg tablet
       
    • Chantix 1 mg continuing monthly pack
       
    • Chantix 1 mg tablet
       
    • Chantix starting monthly pack
       
    • Nicotrol cartridge inhaler
       
    • Nicotrol NS Spray 10 mg/ml
       
  • Over-the-counter (OTC) medications

Notes:
 
  • To receive benefits for over-the-counter (OTC) smoking, tobacco, and E-cigarette 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, tobacco, and E-cigarette cessation medications not meeting these criteria. Benefits are not available for over-the-counter (OTC) smoking, tobacco, and E-cigarette cessation medications except as described above.
     
  • See page 58 for our coverage of smoking, tobacco, and E-cigarette cessation treatment, counseling, and classes.

You Pay
Preferred retail pharmacy: Nothing

Non-preferred retail pharmacy: You pay all charges
 
Benefits Description

Specialty Drug Pharmacy Program


We cover specialty drugs that are listed on the FEP Blue Focus Specialty Drug List. This list is subject to change. For the most up-to-date list, call the telephone number below or visit our website, www.fepblue.org. (See page 138 for the definition of “specialty drugs.”)

Each time you order a new specialty drug or refill, a Specialty Drug pharmacy representative will work with you to arrange a delivery time and location that are most convenient for you, as well as ask you about any side effects you may be experiencing. See page 116 for more details about the Program.

You Pay
Specialty Drug Pharmacy Program

Tier 2:
  • 40% of the Plan allowance (up to a $350 maximum) for each purchase of up to a 30-day supply
     
  • If a 31 to 90-day supply of a specialty drug has to be dispensed due to manufacturer packaging, you pay 40% of the Plan allowance (up to a $1,050 maximum) for each purchase.

Non-preferred specialty drug pharmacy: You pay all charges
 
Covered Medications and Supplies - continued on next page