Q1: What is a generic drug?
A1: According to the Food and Drug Administration a generic drug is a copy that is identical to a brand name drug in dosage, safety, strength, how it is taken, quality, performance and intended use. Generic drugs use the same active ingredients and are shown to work the same way in the body as their brand name counterparts. Both generic and brand name drugs are regulated by the Food and Drug Administration and tested to be safe and effective for their intended use. When a brand name drug has a patent that expires, drug companies can introduce, at a lower cost, competitive generic versions after the drug has been thoroughly tested and approved by the FDA. Find out more.
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Q2: Why can’t I locate the medication that I take on any of the published lists?
A2: There are thousands of covered prescription medications. The prescription medication lists contain only those covered medications that need to be called to your attention for a specific reason. For instance, the preferred prescription list shows the medications that are preferred by this plan because of their effectiveness and cost. The prior approval and quantity limitation lists both contain medications with special requirements for coverage.
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Q3: How are the lists of prescriptions requiring prior approval and prescriptions with quantity limitations determined and how can they be changed?
A3: (See updated lists.)

These lists are developed and maintained by the Pharmacy and Therapeutics Committee. This committee consists of BlueCross BlueShield of Tennessee pharmacists and physicians as well as practitioners from the community. The lists are established annually and reviewed quarterly and contain medications that are clinically effective as well as cost effective. A member or provider may suggest changes to these lists by faxing their suggestion to 888-343-4232. Each suggestion or request will receive a written response. However, please be aware that the Pharmacy and Therapeutics Committee reviews all suggestions at the quarterly meeting.

Q4: Are the medications on the Preferred Drug List the preferred brand drugs?
A4: The preferred brand drug list includes both preferred generic drugs and preferred brand drugs. This prescription medication plan has three levels of copay or coinsurance. The smallest copay/coinsurance applies to generic drugs. The middle level copay/coinsurance applies to preferred brand drugs. Non-preferred brand drugs are subject to the highest copay/coinsurance. On the Preferred Drug List, the generic drugs start with a lower case letter and the brand drugs start with a capital letter. The copay/coinsurance is determined by whether the drug is generic or brand, not by whether or not it is on the list.
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Q5: I’ve heard that some retail pharmacies are part of the prescription home delivery network. Can I use these pharmacies for prescription home delivery?
A5: Yes, some independent pharmacies, including many major chain store pharmacies, are contracted to participate in the home delivery pharmacy network. Members may obtain up to a 102-day supply of medication for one copayment or coinsurance amount at these participating pharmacies. Contact member service at the number on your identification card to determine if a retail pharmacy in your area participates in the home delivery network.
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Q6: I want to begin using one of the participating home delivery network pharmacies but my prescriptions are on file with Caremark.com. How do I get my prescriptions transferred to a participating retail pharmacy?
A6: If a member wishes to have existing prescriptions transferred from Caremark.com to a participating retail pharmacy, they should have the retail pharmacy that participates in the home delivery network do one of the following:

• Call Caremark at 1-877-278-0586 Ext.4661and request the prescription be transferred to the retail pharmacy; or
• the pharmacist can contact the physician on behalf of the member and request a new prescription for up to a 102-day supply.

Q7: Caremark Home Delivery recently sent me my medication. I was expecting generic, but they sent the more expensive brand. When I called, they indicated that there was no A/B rated generic drug available. What does this mean?
A7: The FDA rates generic drugs in two areas: chemistry/manufacturing and bioavailability/bioequivalence. Generic drug manufacturers must prove to the FDA that the generic drug is consistent in potency, stability and sterility to the brand drug. The generic drug must also show that it has the same absorption rate from the gastrointestinal tract to the bloodstream as the brand drug. Generic drugs are rated based on a two-letter code (for example AA, AB, and B_). A generic drug that is AB rated (most generics are AB rated) has had differences in bioavailability/bioequivalence from the innovator of the drug that has been resolved to the satisfaction of the FDA. Caremark will only ship generic drugs that have at least met the requirements for the AB rating.
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Q8: Does my plan use a “maintenance list” of prescription medication?
A8: No, the State account plans (PPO & PPO-Limited) do not utilize a maintenance list of drugs. All covered prescription medication can be purchased either at a retail pharmacy for up to a 34-day supply or the prescription home delivery program for up to a 102-day supply. Some retail pharmacies participate in the home delivery program. Contact member service at the number on your ID card for a list of home delivery retail pharmacies.
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Q9: What is a compound drug and how do I get compounded medication?
A9: Compound drugs (drugs that are combined), should be purchased at a participating retail pharmacy or the prescription home delivery program. Some compounded drugs have a limited shelf life and therefore have a quantity purchase limit. For example, if the compounded medication has an expiration date of one month from the date of fill, then it will only be filled for one month (30-34 days) at a time.
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Q10: Why didn't I receive an Explanation of Benefits form (EOB) from BlueCross for my drug purchases?
A10: Since BlueCross BlueShield of Tennessee contracts with Caremark to administer pharmacy benefits, Explanation of Benefit forms (EOB) are not generated for prescription drug claims. If you have a question regarding claims processing for prescription medication you purchased, contact member service at the number on your identification card.
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Q11: My drug benefits allow me to receive up to a 102-day supply for medication purchased through the home delivery program. Why did I only receive a 90-day supply?
A11: The home delivery program can only fill a prescription for the quantity indicated by your physician on the original prescription form. Most physicians are accustomed to writing the prescription for either a 30 or 90 day supply. Make sure your physician indicates either a 34 or 102-day on the prescription so that you can obtain the maximum amount covered by your plan.
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Q12: I used the home delivery program and expected to receive 102 tablets/pills. I only received 90. Why was I shorted?
A12: Some medications come in restrictive or pre-packaged amounts. For example, a medication may be pre-packaged in a 45-day supply only. Medication ordered through the home delivery program is filled by Caremark at their mail order facility. Caremark will not break apart pre-packaged medication. In this example, a member will receive a 90 day supply for one copayment when using the home delivery option.
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