Important details about your drug plan

Important details about your drug plan

Your prescription drug coverage from BlueCross BlueShield of Tennessee includes certain programs, lists and tools to help you make the most of your benefits. Always check your Evidence of Coverage, contract or member handbook for specific details. Then work with your doctor and pharmacist to make smart choices about the drugs you take and the amount you pay.

First step? Getting familiar with these terms, tools and programs:

  • Preferred Drug List. A convenient listing of the preferred brand drugs and generic medications that help save you money on your prescription costs. Always check the Preferred Drug List to see if it includes a drug that you currently take. If not, talk with your doctor to see if one of the preferred drugs would be just as effective for you.
  • Specialty Pharmacy Drug List. A list of certain injectable, infusion and oral medications that require complex care, special handling and use. These medications are either given by the doctor (as provider-administered) or taken in the home (as self-administered), and are available through a Specialty Pharmacy Network. You get the highest level of benefits - and save the most money - when you order Specialty Pharmacy drugs through one of the three preferred specialty pharmacy vendors.
  • Prior Authorization List. Specific drugs that may need authorization from your benefit plan before they are dispensed by your pharmacy. Network doctors are usually familiar with this list and know how to obtain prior authorization. But you may want to show this list to your doctor - especially if you use an out-of-network doctor or a doctor outside Tennessee.
  • Quantity Limitations List. In keeping with standard medical practices, certain drugs have limits on the amount that can be purchased at one time. Benefits for most covered prescriptions are provided for up to a month's supply. But benefits for some drugs are limited to a specific amount or dose.

Remember: Some types of medications may not be covered by your plan. Always review the Limitations and Exclusions section of your Evidence of Coverage or member handbook so you will know what is not covered. An exclusion does not mean you cannot have a particular drug. It simply means that no benefits will be provided, and you will be responsible for the drug cost.

Page Modified:May 18, 2012