2015 Pharmacy Benefit Summary Book

2015 Pharmacy Benefit Summary Book
Review this summary booklet to
learn how to get the most from your
prescription benefit. This includes
information about:
»» Your prescription drug benefits
»» Your formulary and cost share
»» Highlights from your health plan
»» Ways to save money with Basic and
Standard Options
Your prescription drug benefit
The Blue Cross and Blue Shield Service
Benefit Plan works with CVS/caremark to
administer your prescription benefit.
CVS/caremark is an independent company
called a Pharmacy Benefit Manager (PBM).
The PBM manages your:
»» Retail Pharmacy Program Network
»» Mail Service Prescription Drug Program
»» Specialty Pharmacy Program
General questions
If you have any questions about your
benefits, please:
»» See your Blue Cross and Blue Shield
Service Benefit Plan brochure
(RI-71-005)
»» Visit www.fepblue.org
»» Call CVS/caremark Customer Care
any time toll-free at 1-800-624-5060
TABLE OF CONTENTS
Your Prescription Drug Benefit - 4
Prescription Drug Coverage
Prior Approval
Specialty Pharmacy Program
Health Plan Highlights - 6
Contraceptive Benefit
Diabetic Benefit
Prescription Benefits Overseas
Drugs from Other Sources
Ways to Save with Basic Option - 8
Be a smart consumer
Partner with your doctor and pharmacist
Manage your health and your money with
generics
Use Preferred brand name drugs
Use a Preferred retail pharmacy
Your Basic Option Cost Share - 9
Basic Option Pharmacy Providers
Facts to know about Basic Option costs
Ways to Save with Standard Option - 10
Be a smart consumer
Partner with your doctor and pharmacist
Manage your health and your money with
generics
Use Preferred brand name drugs
Use Mail Service for long-term prescription
drugs
If you don’t use Mail Service, use a Preferred
retail pharmacy
Your Standard Option Cost Share - 13
Standard Option Pharmacy Providers
Facts to know about Standard Option costs
How to Contact Us - 14
YOUR PRESCRIPTION DRUG BENEFIT
Understanding your prescription benefit will
save you time and money. Your Basic or
Standard Option benefits will cover much of your
prescription cost.
How tiers relate to costs
Generally, the lower the drug tier, the lower the
cost. Generic drugs (Tier 1) and Preferred brand
name drugs (Tier 2) provide you with high-quality,
cost-effective options.
Prescription Drug Coverage
To quickly check whether your drug is covered:
»» Visit www.fepblue.org and click on the Pharmacy link
»» Call CVS/caremark Customer Care any time
toll-free at 1-800-624-5060
The formulary
The formulary is a complete list of your covered
prescription drugs. It includes both generic and
brand name drugs. The formulary has 5 tiers of
drugs.
Your cost share
The cost of drugs varies. How much you pay is
your cost share. Your cost depends on which
formulary tier your drug is in.
If you are taking a prescription drug and want to
know your cost share:
»» Visit www.fepblue.org and click on the Pharmacy link
How prescription drugs are assigned to tiers
The Pharmacy and Medical Policy Committee
(PMPC) is an independent group of doctors and
pharmacists. This group recommends drugs for
each tier based on their:
»» Effectiveness
»» Safety
»» How they compare to other drugs in the same therapeutic class
The PMPC meets every quarter to review new
drugs and other changes to the formulary. Drugs
may change tiers or prior approval status. Read
on to learn about prior approval, and check your
formulary often to be aware of any changes.
Basic and Standard Options
TIER
DRUG TYPE
Tier 1
Generic Drugs. Typically the most affordable, and are equal to their brand name counterparts in quality, performance characteristics and intended use.
Tier 2
Preferred Brand Name Drugs. Proven to be safe, effective, and favorably priced compared to
Non-preferred brands.
4
Tier 3
Non-preferred Brand Name Drugs. These drugs have either a generic or preferred brand available therefore your cost share will be higher.
Tier 4
Preferred Specialty Drugs. Proven to be safe, effective, and favorably priced compared to
Non-preferred specialty drugs.
Tier 5
Non-preferred Specialty Drugs. These drugs typically have a preferred brand available therefore your cost share will be higher.
Prior Approval
Some prescription drugs and supplies need
approval in advance, or “prior approval” before
we provide coverage for them. We need to find
out if:
»» The drug is related to a service or condition
that is covered under the Service Benefit Plan and
»» The drug is prescribed in a way that matches generally accepted medical practices
Facts to know about prior approval
»» In providing prior approval, we may limit the
amount of drug you receive. We choose drug quantities (for example, number of pills) based on accepted standards
of medical, dental, or psychiatric practice in
the United States
»» You’ll need to renew your prior approval periodically
»» Drugs and supplies on the Prior Approval list
may change throughout the year
»» Mail Service and Specialty Programs will not
fill prescriptions that need prior approval until
you receive prior approval
»» Preferred retail pharmacies will fill your prescriptions, but you will pay full cost until
you get prior approval. File a claim for reimbursement with the Retail Pharmacy Program
The prior approval list
For a list of drugs that need prior approval or to
get a prior approval request form:
»» Visit www.fepblue.org and click on the Pharmacy link
»» Call CVS/caremark Customer Care any time
toll-free at 1-800-624-5060
Specialty Pharmacy Program
A specialty prescription drug is used to treat
complex health conditions. Specialty drugs are
usually high in cost and have one or more of
these elements:
»» Are injectable
»» Are infused
»» Are inhaled
»» Are products of biotechnology
»» Have special requirements for handling, shipping, and storage
»» Need specialized patient training and coordination of care
Facts to know about specialty drugs
»» Specialty drugs in Tier 4 are Preferred
»» Specialty drugs in Tier 5 are Non-preferred
»» Tiers 4 and 5 both have limits on days’ supply (amount of drug) and where you can
get refills
5
HEALTH PLAN HIGHLIGHTS
Contraceptive Benefit
Basic Option
We waive your cost share for generic
contraceptives and brand name contraceptives
that have no generic equivalent or alternative.
This benefit applies when you use a Preferred
retail pharmacy.
This program covers OTC contraceptive drugs
and devices for women in full only when
contraceptives meet FDA standards for OTC
products. To receive benefits, you must:
»» Use a Preferred retail pharmacy
»» Present the pharmacist with a prescription from your doctor
Diabetic Benefit
Standard Option
We waive your cost share for generic
contraceptives and brand name contraceptives
that have no generic equivalent or alternative.
This benefit applies when you use:
»» A Preferred retail pharmacy
»» The Mail Service Prescription Drug Program
Basic or Standard Option contraceptives for
women covered with zero cost share include:
»» Generic contraceptive drugs
»» Brand name contraceptive drugs that have no generic equivalent or alternative
»» Over-the-counter (OTC) contraceptive drugs
and devices, limited to:
-- Emergency contraceptive pills
-- Female condoms
-- Spermicides
-- Sponges
»» Generic devices: at this time, there are no generic equivalents or alternatives for any of the devices on the market. If generic devices become available, we will include them in this coverage with a zero cost share. Examples of future generic devices are:
-- Diaphragms and contraceptive rings
-- Injectable contraceptives
-- IUDs (intrauterine devices)
-- Implantable contraceptives
-- Cervical caps
-- Oral and transdermal contraceptives
6
Basic Option
Members may get insulin and diabetic supplies
from a Preferred retail pharmacy.
Standard Option
Members may get insulin and diabetic supplies
from a Preferred or Non-preferred retail pharmacy
or the Mail Service Prescription Drug Program.
Primary coverage with Medicare Part B
You may also receive insulin and diabetic supplies
from doctors or other healthcare providers.
Get a free blood glucose test meter
The Diabetic Meter Program offers members
with diabetes an ACCU-CHEK or One Touch
glucose meter kit at no cost, once per benefit
year. Each kit includes a glucose meter, and a
starter supply of test strips and lancets. Members
can choose from five (5) different meters offered.
Call CVS/caremark toll-free at 1-855-582-2024
weekdays from 11:00 a.m. to 6:00 p.m. Eastern
time to request a meter.
You can save money by using Preferred test
strips. All five meters offered through this
program are compatible with our Preferred (Tier 2)
test strips.
Prescription Benefits Overseas
Drugs you buy overseas must be equivalent
to drugs that need a prescription in the United
States. This is a U.S. federal law. File a claim
for covered drugs and supplies you buy from
pharmacies outside the United States and Puerto
Rico. Use the following address to send both
your:
»» Completed FEP Retail Prescription Drug Overseas claim form
»» Itemized pharmacy receipts or bills
Blue Cross and Blue Shield
Service Benefit Plan, Retail Pharmacy Program
P.O. Box 52057
Phoenix, AZ 85072-2057
Or fax the information to:
001-480-614-7674
We provide translation and conversion services
for your overseas claims. To get a claim form for
your overseas prescription drug purchases:
»» Write to the above address—use this address for any written questions about drugs you buy outside the United States and
Puerto Rico
»» Visit www.fepblue.org and click on Find a Form
»» Call any time toll-free at 1-888-999-9862
Save time with overseas claims by filing online
with MyBlue
For faster processing and payment, you can also
submit overseas pharmacy claims online. It’s
easy. Just follow these simple steps:
1. Log in to MyBlue at www.fepblue.org/
myblue
2. Click on the blue Submit an overseas claim
box on the right and follow the steps
3. To attach receipts, use these file types:
PDF, jpg, tiff, and bmp
If you’re new to MyBlue, click on the blue Sign
Up box at www.fepblue.org/myblue. Register
as a new member on the Get Going with MyBlue
page, completing all the fields. Once you’re
logged in, follow the steps above.
Drugs from Other Sources
You may get prescription drugs and supplies
from providers other than retail or mail
pharmacies, like:
»» Your doctor
»» Your hospital
»» A government health center
In these cases, you need to pay for your items
and file a claim form for reimbursement:
1. Be sure to get an itemized receipt
2. Then, fill out the FEP Health Benefits claim form
3. Send your form, along with your itemized receipt, to your local Blue Cross and Blue Shield Plan
For drugs and supplies you get from these
providers, your medical coinsurance amounts
apply to covered charges. Check your 2015
Blue Cross and Blue Shield Service Benefit Plan
(RI 71-005) for details.
These are just a few of your health plan
highlights. Your Service Benefit Plan includes so
much more. For other programs such as Tobacco
Cessation Incentive Program, Breast Pump
Program and more, see:
»» Your Blue Cross and Blue Shield Service Benefit Plan brochure (RI 71-005)
»» The Blue Cross and Blue Shield Service Benefit Plan website at www.fepblue.org
7
WAYS TO SAVE WITH BASIC OPTION
1. Be a smart consumer.
Each year, the prescription drug industry spends
more than $4 billion to promote its brands. Those
costs are passed along to insurance companies,
businesses, and you. So choose a drug based on
its effectiveness, not its advertising slogan.
2. Partner with your doctor and pharmacist.
Your doctor and pharmacist are key members of
your healthcare team. They are the experts on
health conditions and the prescription drugs used
to treat them. Remember to ask questions if you
don’t understand something. The more you know
about your condition and prescription drugs, the
better off you will be. Here are some questions
you might ask your doctor or pharmacist:
»» Why do I need to take this prescription drug?
»» What is the right way to take it?
»» How often should I take it?
»» Should I take it with food or water?
»» Should I avoid other drugs or foods while I’m taking it?
»» Is this a generic drug?
»» Is there a generic substitute?
»» Is there a drug on my formulary that might be right for me?
These are just examples of some questions you
might ask. Remember, your doctor or pharmacist
has probably heard your question before, so don’t
be shy to ask. The more you know, the better
you’ll feel.
3. Manage your health and your money with
generics.
The FDA requires that generic drugs are equal
in quality to their brand name counterpart. And
you almost always pay less for a generic. Ask
your doctor to approve generic substitution when
possible.
8
4. Use Preferred brand name drugs.
Preferred brand name drugs have been proven
to be safe, effective, and lower in cost. Your cost
share is always lower with a Preferred brand
name drug compared to a Non-preferred brand
name drug. You may still receive benefits if you
choose Non-preferred drugs, but your out-ofpocket costs are greater.
5. Use a Preferred retail pharmacy.
Just show your ID card at one of the Preferred
retail pharmacies. There are no deductibles to
meet. You only pay your cost share for each
prescription or refill. It’s that easy. You don’t even
have to file a paper claim.
There are more than 65,000 Preferred retail
pharmacies nationwide. Many national and
regional chains are part of the Basic Option
network of retail pharmacies. The network also
includes most independent pharmacies. It may
change from time to time.
Using a Preferred retail pharmacy saves you
money. If you get your drug from a Non-preferred
retail pharmacy, you pay 100% of the prescription
cost. To find a Preferred retail pharmacy near you:
»» Visit www.fepblue.org and click on the Pharmacy link
»» Call CVS/caremark Customer Care any time toll-free at 1-800-624-5060 for the current list of Preferred retail pharmacies
YOUR BASIC OPTION COST SHARE
Basic Option Pharmacy Providers
To receive prescription drug benefits under the
Basic Option plan, you need to use:
»» A Preferred retail pharmacy
»» The Specialty Pharmacy Program (if you use
a specialty drug)
Facts to know about Basic Option costs
»» If you use a Non-preferred retail pharmacy,
your cost share is 100%. This means you pay the full cost of the prescription drug
»» Basic Option does not include the Mail Service Prescription Drug Program
See the following tables for your cost share
based on where you fill your prescription drugs.
1. Your Cost Share at a Preferred Retail Pharmacy (Basic Option)
TIER
PREFERRED RETAIL PHARMACY
Tier 1:
Generic Drugs
-Up
- to $10
-You
- can get up to a 30-day supply for 1 copayment or a 90-day supply for 3 copayments
Tier 2:
Preferred
Brand Name Drugs
-Up
- to $45
-You
- can get up to a 30-day supply for 1 copayment or a 90-day supply for 3 copayments
Tier 3:
Non-preferred
Brand Name Drugs
-50%
of the drug price when the price is $110 or greater
-$55
- copayment or the drug price when the price is less than $110
-You
- can get up to a 30-day supply for 1 copayment or a 90-day supply for 3 copayments
2. Specialty Drugs: Your Cost Share based on Where You Fill Your Prescription
(Basic Option)
TIER
SPECIALTY DRUG PHARMACY
PREFERRED RETAIL PHARMACY
Tier 4:
Preferred
Specialty Drugs
-Up
- to $50 for 30-day supply or $140 for 90-day
s
upply
-You
- are limited to a 30-day supply for the first 3
fills of each specialty drug. You can get a 90-day
supply after the 3rd fill
-Up
- to $60 for up to a 30-day supply only
-When
you buy specialty drugs at a Preferred
retail pharmacy, you are limited to one 30-day
supply for each prescription. You must get all
refills through the Specialty Drug Pharmacy
Tier 5:
Non-preferred
Specialty Drugs
-Up
- to $70 for 30-day supply or $195 for 90-day
s
upply
-You
- are limited to a 30-day supply for the first 3
fills of each specialty drug. You can get a 90-day
supply after the 3rd fill
-Up
- to $80 for up to a 30-day supply only
-When
you buy specialty drugs at a Preferred
retail pharmacy, you are limited to one 30-day
supply for each prescription. You must get all
refills through the Specialty Drug Pharmacy
Be sure to check your Basic Option formulary at www.fepblue.org. Click on the Pharmacy link.
9
WAYS TO SAVE WITH STANDARD OPTION
1. Be a smart consumer.
Each year, the prescription drug industry spends
more than $4 billion to promote its brands. Those
costs are passed along to insurance companies,
businesses, and you. So choose a drug based on
its effectiveness, not its advertising slogan.
2. Partner with your doctor and pharmacist.
Your doctor and pharmacist are key members of
your healthcare team. They are the experts on
health conditions and the prescription drugs used
to treat them. Remember to ask questions if you
don’t understand something. The more you know
about your condition and prescription drugs, the
better off you will be. Here are some questions
you might ask your doctor or pharmacist:
»» Why do I need to take this prescription drug?
»» What is the right way to take it?
»» How often should I take it?
»» Should I take it with food or water?
»» Should I avoid other drugs or foods while I’m taking it?
»» Is this a generic drug?
»» Is there a generic substitute?
»» Is there a drug on my formulary that might be right for me?
These are just examples of some questions you
might ask. Remember, your doctor or pharmacist
has probably heard your question before, so don’t
be shy to ask. The more you know, the better
you’ll feel.
3. Manage your health and your money with
generics.
The FDA requires that generic drugs are equal
in quality to their brand name counterpart. And
you almost always pay less for a generic. Ask
your doctor to approve generic substitution when
possible.
10
Standard Option Generic Incentive Program
(GIP)
It pays to make the switch from brand name
drugs to generics. We waive your cost share for
the first four (4) prescriptions filled (and/or refills
ordered) per generic drug each calendar year
when:
»» You switch from a brand name drug on the
GIP list to a generic drug replacement (not from one generic to another generic), and
»» You buy both the brand name drug and the corresponding generic drug replacement
during the same calendar year
4. Use Preferred brand name drugs.
Preferred brand name drugs have been proven
to be safe, effective, and lower in cost. Your cost
share is always lower with a Preferred brand
name drug compared to a Non-preferred brand
name drug. You may still receive benefits if you
choose Non-preferred brand name drugs. But
your out-of-pocket costs are greater.
5. Use Mail Service for long-term prescription
drugs.
The Mail Service Prescription Drug Program is
a convenient and cost-effective way to get your
maintenance or long-term drugs. These are drugs
you take regularly, and need to take long-term.
Examples might include drugs for high blood
pressure, arthritis, or other chronic conditions.
You can get a 90-day supply (minimum 22-day
supply) of long-term drugs for one copayment.
Choose to have these drugs sent to your home,
office, or a location of your choice with free
standard shipping. By using Mail Service, you
save time avoiding trips to the pharmacy.
How to order new prescriptions through Mail
Service
»» Online: to order prescription drugs or ask about the status of your order any time,visit
www.fepblue.org/myblue to register or log in to your Caremark account. You will be able to manage all of your prescription benefits, find time saving tools and get easy
refills »» By phone: have your doctor order your new prescriptions by calling the automated CVS/caremark Customer Care line toll-free at 1-800-262-7890
»» By mail: for each prescription you order, complete a CVS/caremark Mail Service Order Form. To request an order form, please call Customer Care toll-free 1-800-262-7890, or visit
www.fepblue.org. Mail the form, your prescription, and your copayment to the address on the form:
CVS/caremark
P.O. Box 1590
Pittsburgh, PA 15230-9607
How to order refills through Mail Service
»» Online: visit www.fepblue.org and click on
t
he Pharmacy link
»» By phone: call toll-free at 1-877-FEP-FILL (1-877-337-3455)
»» If you have questions or need more order forms, please visit www.fepblue.org or call
Customer Care any time toll-free at 1-800-262-7890. You can also use this number any time if you need a consultation
with a pharmacist
6. If you don’t use Mail Service, use a Preferred
retail pharmacy.
Using a Preferred retail pharmacy saves you
money and time. You just show your ID card.
There are no deductibles to meet. You pay only
your coinsurance under Standard Option for each
prescription or refill. It’s that easy. And you don’t
have to file a claim. There are more than 65,000
Preferred retail pharmacies nationwide.
To find a Preferred retail pharmacy:
»» Online: visit www.fepblue.org and click on
t
he Pharmacy link
»» By phone: call CVS/caremark Customer Care any time toll-free at 1-800-624-5060 for the current list of Preferred retail pharmacies. You can call any time to get the
list of Preferred retail pharmacies in your area
Facts to know about Mail Service
»» If the cost of your prescription is less than your copayment, you pay only the cost of your prescription. Mail Service charges you the lesser of the prescription cost or copayment when you place your order
»» Please allow up to 2 weeks to get your order
in the mail. Please also read the package insert with your order. This insert has full details about your drug and how to take it
11
Non-preferred Retail Pharmacies
You may still buy your prescription drugs and
supplies from Non-preferred retail pharmacies. To
do so:
1. Pay the full price for the prescription
2. Get an itemized receipt from the Nonpreferred retail pharmacy. The receipt
should show the name and address of the
pharmacy, patient’s name, prescription
number, date filled, name of drug or supply,
strength, quantity, dosage, and charge for
each drug or supply
3. Ask your pharmacist to help you fill out the
Pharmacy Information and Prescription
Information sections of the Retail
Prescription Drug claim form. To get a claim
form:
-Visit
www.fepblue.org and click on Find a Form
-Call
the Retail Pharmacy Program any
time toll-free at 1-800-624-5060
4. Fill in the Member and Patient information
and sign the claim form
5. Send the completed claim form and any
related pharmacy receipt(s) to:
Blue Cross and Blue Shield
Service Benefit Plan, Retail Pharmacy
Program
P.O. Box 52057
Phoenix, AZ 85072-2057
Facts to know about Non-preferred retail
pharmacies
»» We reimburse you up to 55% of the average
wholesale price for covered drugs and supplies purchased at a Non-preferred retail
p
harmacy
»» You’re free to buy your covered drugs and supplies at a Non-preferred retail pharmacy.
But you get greater convenience and time savings when you use a Preferred retail pharmacy or the Mail Service Prescription Drug Program
12
»» You can change from a Non-preferred to a Preferred retail pharmacy. Just go into any Preferred retail pharmacy. Tell the pharmacist where your prescription is on file. The pharmacist will contact the Non-preferred retail pharmacy and transfer your prescription
Hospital outpatient departments
Most hospital outpatient pharmacies are Nonpreferred retail pharmacies.
Charges only for prescription drugs and covered
supplies
If the outpatient hospital bill includes charges only
for prescription drugs and covered supplies:
1. We will process the claim through the Retail
Pharmacy Program
2. Pay for your items and then file a Retail
Pharmacy claim form
3. Include the itemized bill from the hospital
with your claim to the Retail Pharmacy
Program
Charges for prescription drugs and covered
supplies as part of medical treatment
If the outpatient hospital bill includes charges for
drugs or supplies as part of expenses for medical
treatment:
1. Your local Blue Cross and Blue Shield Plan
will process the claim
2. Most hospitals will file these outpatient
charges for you
3. If the hospital does not file the claim for you,
fill out a Health Benefits claim form
4. Attach your itemized hospital bill, and send
the claim to your local Blue Cross and Blue
Shield Plan. For a copy of the claim form,
visit www.fepblue.org and click on Find a
Form
YOUR STANDARD OPTION COST SHARE
Standard Option Pharmacy Providers
Your cost share depends on where you fill your
prescription drugs:
1. Preferred retail pharmacy
2. Non-preferred retail pharmacy
3. Mail Order Pharmacy
4. Specialty Drug Pharmacy (if you use a
specialty drug)
Facts to know about Standard Option costs
»» For Tier 1, Tier 2 and Tier 3 drugs, you can receive up to a 90-day supply from either the
Retail or Mail Order Pharmacy Program
»» Generic drugs usually have the lowest cost
s
hare
»» Non-preferred brand name drugs usually have the highest cost share
See the following tables for your cost share
based on where you fill your prescription drugs.
1. Your Cost Share based on Where You Fill Your Prescription (Standard Option)
TIER
CAREMARK MAIL ORDER
PREFERRED RETAIL
NON-PREFERRED RETAIL
PHARMACY
PHARMACY
PHARMACY
Tier 1: Generic
Drugs
-Up
- to $15
-Members
with Medicare
Part B: Up to $10
-20%
of the plan allowance
-Members
with Medicare
Part B: 15% of plan allowance
Tier 2: Preferred
Brand Name
Drugs
Up to $80
30% of the plan allowance
Tier 3: Nonpreferred Brand
Name Drugs
Up to $105
45% of the plan allowance
-45%
of the average wholesale price plus any difference between the allowance and the billed
a
mount
-If
- you use a Non-preferred
retail pharmacy, you need
to file a paper claim for reimbursement
See next page for additional table »
13
2. Specialty Drugs: Your Cost Share based on Where You Fill Your Prescription (Standard Option)
PREFERRED OR NON-PREFERRED RETAIL
TIER
SPECIALTY DRUG PHARMACY
PHARMACY
Tier 4:
Preferred
Specialty Drugs
-$35
- for up to 30-day supply
-$95
- for up to 90-day supply
-You
- are limited to a 30-day supply for the first 3
fills of each specialty drug. You can get a 90-day
supply after the 3rd fill
Tier 5:
Non-preferred
Specialty Drugs
-Up
- to $55 for 30-day supply
-$155
for 90-day supply
-You
- are limited to a 30-day supply for the first 3
fills of each specialty drug. You can get a 90-day
supply after the 3rd fill
-30%
coinsurance-Up to 30-day supply
-When
you buy specialty drugs at a Preferred
retail pharmacy, you are limited to one
30-day supply for each prescription. You must get all refills through the Specialty
Drug Pharmacy
Be sure to check your Standard Option formulary at www.fepblue.org. Click on the Pharmacy link.
HOW TO CONTACT US
Call these numbers for prescription drug
information:
Retail Pharmacy Program
(Standard & Basic Option)
Toll-free any time at 1-800-624-5060
Mail Service Prescription Drug Program
(Standard Option Only)
Toll-free any time at 1-800-262-7890
Specialty Pharmacy Program
(Standard & Basic Option)
Toll-free at 1-888-346-3731
Monday-Friday: 7 a.m. to 9 p.m. (ET)
Saturday/Sunday: 8 a.m. to 6:30 p.m. (ET)
14
Other Benefit or Claims Information
Call your local Blue Cross and Blue Shield Plan.
The customer service number is on the back of
your Service Benefit Plan ID card.
This pamphlet gives a summary of your
prescription drug benefits. For complete details
on your benefits, please refer to the 2015 Blue
Cross and Blue Shield Service Benefit Plan
brochure (RI 71-005).

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