2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits
Page 102
 
Benefits Description

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:

 
  • 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