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 cl inical 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 AdvantageSM 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.
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
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.
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 benefit 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 to you for the remainder of the benefit year. We feel it is important that you have continued access for the remainder of the benefit 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 6.1 CMS Approved 03242014