Getting Your Prescription Drugs

Under certain circumstances, you may be able to get a temporary supply of a drug when your drug is not on the Drug List or when it is restricted in some way. This gives you time to talk with your provider about your options. To be eligible for a temporary supply, you must meet the two requirements below:

1. The change to your drug coverage must be ONE of the following types of changes:
• The drug you have been taking is no longer in the formulary
• The drug you have been taking is now restricted in some way
2. You must be in ONE of the situations described below:
• Members who are new or who were in the plan last year and aren’t in a long-term care (LTC) facility: We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you were new and during the first 90 days of the calendar year if you were in the plan last year. This temporary supply will be for a maximum of a 30-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 30-day supply of medication. The prescription must be filled at a network pharmacy.
• Members who are new or who were in the plan last year and reside in a long-term care (LTC) facility: We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you are new and during the first 90 days of the calendar year if you were in the plan last year. The total supply will be for a maximum of a 98-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 98-day supply of medication. The long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.
• Members who have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away: We will cover one 31-day supply of a particular drug, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.

People with limited incomes may qualify for "Extra Help" to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, copays and/or coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.

Many people are eligible for these savings and don’t even know it. For more information about this "Extra Help," contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

To find out more about Medicaid and its programs, contact:

Blue Advantage works with Rx Savings Solutions (RxSS) to help you find the lowest-price options for your prescription medications. This service is linked to your health plan, so everything is personalized for your medications and insurance. Activate your account or log in by clicking the button below or by calling 1-800-268-4476.

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