Section 5(f). Prescription Drug Benefits

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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

2023 Rate Information

Entire brochure in page-number order

Blue Cross and Blue Shield Service Benefit Plan Brochure - 2023

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

Important contact information

Patient Safety and Quality Monitoring (PSQM)

Standard Option Generic Incentive Program

Asthma Medications

Anti-hypertensive Medications

Additional Covered Medications and Supplies

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

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

Diabetic Meter Program

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

Other Preferred Diabetic Medications, Test Strips, and Supplies

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 Narcan nasal spray and naloxone

How to obtain your prescription drugs and supplies

Smoking and Tobacco Cessation Medications

Drugs From Other Sources

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