BCBS - Prescription Drugs
What should I consider before I fill a prescription drug?
Here are few things to keep in mind before you fill a prescription drug.
• Use a participating pharmacy and Preferred Generic drugs (when available) to
lower your cost (see your cost now by using our Drug Pricing tool).
Using mail-order for ongoing maintenance medication may also save you money.
• Some drugs may require your doctor to submit a prior authorization before
they’re covered (See drugs that may require Prior Authorization in our
Medication Guide).
• Some drugs may be limited in the amount you can fill within thirty days,
unless a special approval is obtained (see the Responsible Quantity Program in
our Medication Guide).
• For plans that cover brand name drugs, certain brand name drugs may not be
covered or will cost you more unless you have tried the generic alternative
first (see the Responsible Steps Program in our Medication Guide).
• Many specialty drugs require a Prior Authorization and must be purchased from
our Specialty Pharmacy network, Caremark to pay the lowest amount. Call
Caremark at 1-866-278-5108 for more information (see more about Specialty Drugs
in our Medication Guide).
IMPORTANT NOTE: Not all health plans come with pharmacy coverage and coverage
varies by plan. If you’re part of an employer group, your employer may provide
prescription drug benefits through another company. Please refer to your
Benefit Booklet for coverage details, limitations and exclusions.
If I am outside the state of Florida and need to have a prescription filled,
what do I do?
When you’re outside the state of Florida, take your prescription to a pharmacy
that participates in our National Pharmacy Network. You can find National
Participating pharmacies using our pharmacy website. If you don’t
have your member ID card with you, you’ll have to pay for your prescription
drug in full and then submit a claim form along with your receipt to the
address shown on the form. If you go to a non-participating pharmacy,
reimbursement will be based on our contracted rate (what we pay a participating
pharmacy), less the amount of your applicable deductible and/or coinsurance.
For help locating a National participating pharmacy, call the Customer Service
number listed on your member ID card.
I went to a BCBSF participating pharmacy and left my ID card at home. I paid
for my prescription drug in full. What do I do?
Simply complete the Claim Form(PDF), attach your receipt and send to the address
indicated on the form.
I left my ID card at home and paid full price for my medication. How do I
get reimbursed?
You have two reimbursement options:
1) If you return to the pharmacy with your ID card, within two weeks of your
purchase, most pharmacies will rerun the prescription claim and reimburse the
amount owed to you.
2) You can complete a Prescription Drug Program Claim form, attach your
receipt(s) and send to the address shown on the form. Reimbursement will be
based on our contracted rate (what we pay participating pharmacies), less the
amount of your applicable copayment or deductible and/or coinsurance.
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