2019 BlueSM Retiree Rx (PDP)

 

2019 Enroll Now

 

How Much Does Blue Retiree Rx Cost?

The monthly premium for Blue Retiree Rx is $41.90. You must continue to pay your Medicare Part B premium.

Where Can I Get My Prescriptions?

BlueCross BlueShield of South Carolina has formed a network of pharmacies that you must use to receive Blue Retiree Rx plan benefits. In general, you must use network pharmacies to access your prescription drug benefit, except in special circumstances. Our network includes pharmacies with preferred cost-sharing, which may offer you lower cost-sharing than the standard cost-sharing offered by other pharmacies within the network. The pharmacy network may change at any time. You will receive notice when necessary. For an up-to-date list of the pharmacies in our network, see our Pharmacy Directory, or search by pharmacy name or location using the Pharmacy Locator. (This link leads to a third-party website.)

How Can I Compare My Options?

You can compare Blue Retiree Rx to other plans using our Summary of Benefits. Please note the Summary of Benefits doesn't list every service that we cover, or list every limitation or exclusion. To get a complete list of our benefits, please review the Annual Notice of Changes & Evidence of Coverage.

Extra Help

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/seven days a week.
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
  • Your state Medicaid Office.

Learn more about the Medicare Extra Help program. This program provides additional help for people with limited income. You can also view the Centers for Medicare and Medicaid Services' (CMS) Best Available Evidence (BAE) policy.

What Prescriptions Are Covered?

Blue Retiree Rx uses a prescription drug list. The formulary may change at any time. You will receive notice when necessary. We may occasionally make changes to the list. For the most current information, see our Comprehensive Formulary (list of covered prescription drugs effective 2/1/2019) or our Drug Search Tool. (This link leads to a third-party website.) Restrictions may apply. For a list of upcoming changes, see the Formulary Change Notice.

Utilization Management

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include Prior Authorization, Quantity Limits or Step Therapy. Links to our plan's Prior Authorization and Step Therapy criteria are below.

  • Prior Authorization: Requires you or your physician to get prior authorization for certain drugs. This means you will need to get approval before you fill your prescriptions. If you don’t get approval, the plan may not cover the drug.
  • Quantity Limits: For certain drugs, the plan limits the amount of the drug that will be covered.
  • Step Therapy: In some cases, the plan requires you to first try certain drugs to treat your medical condition before another drug will be covered for that condition.

To see if your prescription drug has any additional requirements or limits on coverage, refer to the most current Comprehensive Formulary.

Medication Therapy Management (MTM) Program

The MTM program is a free service for eligible members of our plan and is not considered a benefit. This program is designed to help members keep their medications on the right track. MTM is a program offered by CVS/Caremark. CVS/Caremark is an independent company that offers pharmacy benefit management services on behalf of BlueCross. The purpose of the program is to:

  • Make sure all your medications are the right choice for your medical conditions
  • Teach you how to get the most from your medications
  • Lower your risk for potential harmful drug reactions and side effects
  • Teach you why it's important to take your medications on time
  • Help you potentially find ways to save money

It's easy to get started in the MTM program. If you are eligible, you are automatically enrolled, and you will receive a letter in the mail inviting you to participate. There is no added cost for participating, and you may decline individual services or opt-out of the program at any time. Learn more about the MTM Program.

Coverage Determinations & Redeterminations

Coverage determinations are decisions we make about whether a drug prescribed for you is covered by the plan and the amount, if any, we are required to pay for the prescription. If you are not satisfied with the outcome of a coverage determination, you can appeal the decision by requesting a redetermination. Learn more about coverage determinations and redeterminations, and filing grievances. Call a customer service representative to get an aggregate number of grievances, appeals and exceptions filed with Blue Retiree Rx.

To request a coverage determination or a redetermination:

More Important Information

LIS Premium Summary Chart
Transition Policy 
Multi-Language and Non-Discrimination Policy
Beneficiary Rights and Responsibilities Upon Disenrollment
Out-of-Network Coverage Rules
Our Privacy Practices 
Prescription Drug Claim Form

BlueCross BlueShield of South Carolina does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in our health plans, when we enroll members or provide benefits. Free language interpretation services are available for those who cannot read or speak English. Read our Non-Discrimination Statement and Foreign Language Access policy here.

How to Contact Us

Toll-free phone number: 1-800-930-2836 (TTY 711)
Please call our customer service representatives from 8 a.m. - 8 p.m. (Eastern Time), seven days a week.
Fax number: (803) 462-2590
Address: Medicare Advantage, BlueCross BlueShield of South Carolina, P.O. Box 100191, Columbia, SC 29202-3191

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Blue Retiree Rx is a stand-alone prescription drug plan with a Medicare contract. Enrollment in Blue Retiree Rx depends on contract renewal.

Last updated: 1/28/2019