BlueCross BlueShield of South Carolina Total Value Prescription Drug Information

Where Can I Get My Prescriptions?

BlueCross has formed a network of pharmacies that you must use to receive BlueCross Total Value prescription drug benefits. In general, you must use network pharmacies to access your prescription drug benefit, except in special circumstances. 

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. If you would like a Pharmacy Directory mailed to you, please call Customer Service at 1-855-204-2744.

What Prescriptions Are Covered?

BlueCross Total has a List of Covered Prescription Drugs (Formulary). The formulary may change at any time. You will receive notice when necessary. For the most current information, see our Comprehensive Formulary (list of covered prescription drugs effective 09/01/2021) 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. For information about our preferred vendor for blood glucose test strips, see our Preferred Test Strips Vendor 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.

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

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. The purpose 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 BlueCross Total.

To request a drug coverage determination or a redetermination:

You can name another person to act as your “representative” and ask for a coverage determination or redetermination on your behalf, such as a friend, relative, doctor or other prescriber. To have a representative act on your behalf, both you and the representative must sign the Appointment of Representative form.

More Important Information

Transition Policy 
Multi-Language and Non-Discrimination Policy
Out-of-Network Drug Coverage Rules 
Beneficiary Rights and Responsibilities Upon Disenrollment 
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. To read our Non-Discrimination Statement and Foreign Language Access policy, click here.

How to Contact Us

  • Toll-free phone number: 1-855-204-2744 (TTY 711). Please call our customer service representatives from 8 a.m. – 8 p.m. (Eastern Time), seven days a week.
  • Fax: (803) 462-2590
  • Address: Medicare Advantage, BlueCross BlueShield of South Carolina, P.O. Box 100191, Columbia, SC 29202-3191

Submit feedback to Medicare about your BlueCross Total Value plan 
Find out how the Medicare Beneficiary Ombudsman works for you

BlueCross Total Value is a Medicare Advantage PPO plan with a Medicare contract. Enrollment in BlueCross Total depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on Jan. 1 of each year.

Last updated: 09/10/2021