2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits
Page 102
Section 5(f). Prescription Drug Benefits
Page 102
Benefits Description
Covered Medications and Supplies (cont.)
You Pay
All charges
Covered Medications and Supplies (cont.)
- Drugs purchased through the mail or internet from pharmacies inside or outside the United States by members located in the United States
- Over-the-counter (OTC) contraceptive drugs and devices, except as described on pages 96-97
- Drugs used to terminate pregnancy
- Sublingual allergy desensitization drugs, except as described on page 51
You Pay
All charges
Benefit 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:
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, see page 99
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
Benefit Description
Auto-immune infusion medications: Remicade, Renflexis and Inflectra
Note: 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).
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
Auto-immune infusion medications: Remicade, Renflexis and Inflectra
Note: 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).
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