Medications and drug formulary for members with Part D coverage
Each Medicare drug plan has its own formulary (a list of covered prescription drugs).
The BCN Advantage℠ Comprehensive Formulary is a list of FDA-approved medications that have been reviewed by a team of Michigan pharmacists, physicians and other health care experts. We select covered drugs based on their clinical effectiveness, safety and cost effectiveness. Blue Care Network will generally cover medications listed in our formulary as long as the drug is medically necessary, the prescription is filled at a BCN Advantage network pharmacy and other plan rules are followed.
Note: Not all Medicare Advantage group plans have Part D prescription coverage. If your employer or union group has other BCN drug coverage, visit the non-Part D drug coverage for more information.
Fax the completed form to 1-800-459-8027, or mail to:
Blue Care Network Advantage
Pharmacy Help Desk – Mail Code C303
P.O. Box 807
Southfield, MI 48037
Want to file a Coverage Determination?
If we deny your exception request, you can appeal our decision by phone or in writing by clicking below and completing the Request for Redetermination of Medicare Prescription Drug Denial form.
Part D prescription drug tiers
Part D drugs are grouped into the following "tiers":
These drugs have a proven record of safety and effectiveness and offer the best value for the member. Because they are Tier 1, they require the lowest copay, making them the most cost-effective option for treatment. Generic drugs are rated by the Food and Drug Administration to be as safe and effective as brand-name drugs and are available for a fraction of the cost.
These drugs also have a proven record of safety and effectiveness. Because they are Tier 2, they require a higher copay than Tier 1 generics. Generic drugs are rated by the Food and Drug Administration to be as safe and effective as brand-name drugs and are available for a fraction of the cost.
Our Tier 3 drugs also have a record of safety and effectiveness. Since a more cost-effective generic alternative is usually available for these drugs, Tier 3 medications require a higher copay than Tier 1 or Tier 2 drugs.
Non-preferred brand drugs may not have a proven record for safety or their clinical value may not be as high as the drugs in Tier 1, 2 or 3. Formulary alternatives are available. Tier 4 medications require a higher copay.
These drugs have a unique way of working and are very high cost drugs. Usually, your highest copay or coinsurance will apply.
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 contract year except when a new, less expensive generic drug becomes available or when new harmful information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost sharing for those members taking it for the remainder of the contract year. We feel it is important that you have continued access for the remainder of the contract year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety. For more information, see your Evidence of Coverage.
View Evidence of Coverage:
H5883_BCNAdvantage Web 6.0 CMS Approved 11132013