If your drug is not included in the formulary, call customer service at 888-850-8526 (TTY/TDD: 711) Monday to Friday, 8 a.m. to 8 p.m., (or 7 days a week, 8 a.m. to 8 p.m., October 1 to March 31), and ask if your drug is covered.
If you learn that Premera Blue Cross Medicare Advantage plans do not cover your drug, you can:
There are several types of formulary exceptions that you can ask us to make:
For more information on how to request an exception, please see Part D Coverage Determinations, Exceptions, Appeals, and Grievances.
Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year, with these exceptions:
Changes to the drug list that will affect members currently taking a drug:
As a new or continuing member, you may be taking drugs that are not on our formulary (which is the list of drugs covered on your plan), or you may be taking a drug that is on our formulary, but your ability to get it is limited. For example, you may need prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an alternative drug that we cover or request a formulary exception. If a formulary exception request is approved, we will cover the drug you take, even though it is not on the formulary.
While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. This is called a transition supply of drugs.
Here’s how a transition supply is provided to you for each of your drugs not on our formulary or for your covered drugs that are available only with limits, such as prior authorization:
2020 Medicare Advantage Drug Transition Policy
2019 Medicare Advantage Drug Transition Policy
You can fill a long-term supply of some medications using our mail-order pharmacy or at many of the retail pharmacies in our network. What qualifies as a monthly supply and a long-term supply for each of our plans:
Monthly is a maximum 30 day supplyLong-term is a maximum 90 day supply
Premera Blue Cross Medicare Advantage (HMO), Classic (HMO), Classic Plus (HMO), Total Health (HMO), and Core (HMO):
Premera Blue Cross Medicare Advantage Sound + Rx (HMO), Peak + Rx (HMO), Charter + Rx (HMO):