2013 Medication safety for Part D prescription drugs | BCN Advantage

Medications and drug formulary

Each Medicare drug plan has its own formulary (a list of covered prescription drugs).

We select covered drugs based on their clinical effectiveness, safety and cost savings. Blue Care Network will generally cover drugs 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.

Requesting a Part D Coverage Determination

You can ask us to cover a drug that is not on our formulary or waive coverage restrictions or limits on a drug by clicking below and completing a Coverage Determination Request form. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request.

BCN Advantage Member Request for Prescription Drug Determination (PDF)

Fax the completed form to 1-800-459-8027, or mail to:

Blue Care Network Advantage
Pharmacy Help Desk — C303
P.O. Box 807
Southfield, MI 48037

Or email us at BCNPharmacy@bcbsm.com.

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.

Request for Redetermination of Medicare Prescription Drug Denial form (PDF)

Additional information

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 adverse 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 to you 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_BCNAdvantageWebR5.4 Pending CMS Approval

Important Plan and Benefit Information

Important information for BCN Advantage HMO-POS℠ plans

BCN Advantage HMO-POS℠ is available in these counties: Allegan, Barry, Bay, Calhoun, Clare, Clinton, Crawford, Eaton, Genesee, Gladwin, Grand Traverse, Gratiot, Huron, Ingham, Ionia, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lapeer, Livingston, Macomb, Mecosta, Midland, Missaukee, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Roscommon, Saginaw, St. Clair, Sanilac, Shiawassee, Tuscola, Van Buren, Washtenaw and Wayne. Premiums vary by county. You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Medicare beneficiaries may also enroll in BCN Advantage through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. BCN Advantage's contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed. Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1 of each year.

You must use plan providers except in emergency medical or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers without prior authorization from the plan, neither Medicare nor BCN Advantage will be responsible for the costs. Out-of-network services authorized by BCN Advantage will be covered. Our point-of-service benefit allows you to get care from providers not in our network under certain conditions. If you're traveling outside of Michigan, you're covered under our point-of-service BlueCard benefit and can access out-of-network doctors, specialists or hospitals that participate with Blues plans. You may receive most plan-covered services at in-network out-of-pocket cost sharing. You may need to pay higher cost-sharing for routine care from non-network providers.

If your plan includes Part D prescription drug coverage, you must use a network pharmacy to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Our pharmacy network includes the majority of chain pharmacies, mail order through Medco Pharmacy® (now a part of the Express Scripts family of pharmacies) or Walgreens, as well as long-term care and home infusion pharmacies. For more information, call the Customer Service number on the back of your ID card from 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Certain services are available 24/7 through our automated telephone response system. You may also write to: BCN Advantage, 2311 Green Road, Ann Arbor, MI 48105.

The BCN Advantage benefit information provided on this website is not complete. Additional information should be requested before making a decision about your coverage. For full information on BCN Advantage benefits, call the Customer Service number on the back of your ID card from 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Certain services are available 24/7 through our automated telephone response system. If you decide to have your BCN Advantage premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium. For more information, contact BCN Advantage at 1-877-469-2583. TTY users call 711. Hours are: 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30; 8 a.m. to 9 p.m. Eastern time, seven days a week, from Oct. 1 to Feb. 14.

BCN Advantage HMO-POS℠ is a health plan with a Medicare contract.

Important information for the BCN Advantage HMO Focus℠ plan

BCN Advantage HMO Focus℠ is available only to residents of Wayne County. You must use BCN Advantage Focus plan providers except in emergency medical or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers without prior authorization from the plan, neither Medicare nor BCN Advantage will be responsible for the costs. You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Medicare beneficiaries may also enroll in BCN Advantage through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. BCN Advantage's contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed. Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1 of each year.

BCN Advantage HMO Focus℠ plan members must use a network pharmacy to access their prescription drug benefit, except under non-routine circumstances when they cannot reasonably use a network pharmacy. Our pharmacy network includes the majority of chain pharmacies, mail order through Medco Pharmacy® (now a part of the Express Scripts family of pharmacies) or Walgreens, as well as long-term care and home infusion pharmacies. For more information call the Customer Service number on the back of your ID card from 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Certain services are available 24/7 through our automated telephone response system. You may also write to: BCN Advantage, 2311 Green Road, Ann Arbor, MI 48105.

BCN Advantage HMO℠ is a health plan with a Medicare contract.

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2013 Individual plan coverage

Medications and drug formulary

Medications and drug formulary

Requesting a Part D Coverage Determination

Additional information

Important information for BCN Advantage HMO-POS℠ plans

Important information for the BCN Advantage HMO Focus℠ plan