Bcbs Fep Formulary Coverage and Specialty Pharmacy Options

The BCBS FEP formulary offers a range of coverage options for prescription medications.

The BCBS FEP formulary is divided into different tiers, with Tier 1 being the lowest copayment and Tier 4 being the highest.

This tiered system helps patients manage their medication costs and make informed decisions about their care.

BCBS FEP formulary also includes a list of specialty pharmacy options, which provide access to high-cost medications that require special handling and administration.

For more insights, see: Bcbs Fep Pharmacy Prior Authorization Form

The FEP Specialty Pharmacy Program is a great resource for members who are prescribed specialty drugs. This program helps you get them at a reasonable cost.

Exclusively designed for members with specialty drug prescriptions, the FEP Specialty Pharmacy Program is a valuable benefit.

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The FEP Specialty Pharmacy Program is a great resource for members prescribed specialty drugs. It helps you get them at a reasonable cost.

This program is exclusively for members who are prescribed specialty drugs. This means you'll need to be taking one of these specific types of medications to be eligible.

The program's main goal is to make these often expensive medications more affordable. By providing a reasonable cost, it can help reduce the financial burden on members.

If you're prescribed a specialty drug, you can take advantage of this program to get your medication at a lower price.

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If you have prescription drugs or supplies that need prior approval, your healthcare provider can request approval electronically, by fax, or by mail. They'll need to confirm that you're using the drug to treat something your plan covers and that it's prescribed in a medically appropriate way.

Some prescription drugs require prior approval when using your pharmacy benefits. Your healthcare provider can request approval by contacting your local BCBS company. You can download the full list of these select drugs from the company's website.

To give prior approval, your healthcare provider will need to confirm two things: 1. that you’re using the drug to treat something your plan covers and 2. that your healthcare provider prescribes it in a medically appropriate way.

Certain prescription drugs have specific copays and coverage limits. For example, generics have a $5 copay for up to a 30-day supply under FEP Blue Focus. Preferred brand drugs have a 40% copay of the allowance, with a maximum of $350 for up to a 30-day supply.

Broaden your view: Bcbs Drug Formulary 2023

Here's a breakdown of copays for different pharmacy plans:

Keep in mind that cost sharing may be different if Medicare is your primary coverage.

Managing your medications with BCBS FEP is a breeze. You can download the full list of select drugs that require prior approval, so you can plan ahead.

To request prior approval for these select drugs, your healthcare provider can simply contact your local BCBS company. They'll take care of the rest.

Make sure to check the list of select drugs to see if any of your medications are on it. This way, you can plan ahead and avoid any unexpected surprises.

Broaden your view: Bcbs Authorization Tool

Some specific drugs on the BCBS FEP formulary have quantity limits to ensure safe use.

These quantity limits vary by drug, and you can check the MPDP Drug List to see which ones are affected.

Prior approval is required for certain drugs on the approved MPDP drug list, and you can find the full list of Prior approval MPDP Criteria and Step Therapy Criteria on the BCBS FEP website under MPDP Resources by Plan.

This helps ensure that these medications are used responsibly and for the right reasons.

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If you're taking a select drug, your healthcare provider needs to get prior approval before using your medical benefits.

Your healthcare provider can request prior approval by contacting your local BCBS company.

You can download the full list of these select drugs from the provided link.

To get prior approval, your healthcare provider should contact your local BCBS company directly.

For your interest: Provider Bcbs

If you're taking a medication not covered on the BCBS FEP formulary, don't worry, there are alternatives available.

You can find the list of what's not covered and available alternative options for FEP Blue Standard and FEP Blue Basic.

FEP Blue Focus members can apply for coverage of a drug not covered on their drug list with the Non-Formulary Exception Process (NFE) form.

The NFE form is a specific process that allows FEP Blue Focus members to request coverage for a medication that's not on their formulary.

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As a BCBS FEP member, you're eligible for a Standard Option Generic Incentive Program, which can save you money on your prescription costs.

If you switch to a generic medication, your cost share will be waived for your first four prescription fills or refills.

This program is a great opportunity to explore alternative generic drugs that can effectively treat your condition, and you can view the Generic Incentive Program Drug List to see if there's a suitable option for you.

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The Standard Incentive program is a great option for those looking to save on prescription costs. For FEP Blue Standard members, switching to a generic medication can waive the cost share for the first four prescription fills or refills.

You can view and download the Generic Incentive Program Drug List to see if there's an alternative generic drug that can treat your condition.

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FEP Blue Medicare Standards offer lower out-of-pocket costs for higher cost drugs and additional approved prescription drugs in some tiers. Eligible members with Medicare can benefit from these lower costs.

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The FEP Blue Standard program has an annual pharmacy out-of-pocket maximum of $2,000 per member. This limit applies to in-network retail pharmacies and FEP mail service pharmacies.

If Medicare is your primary coverage, certain out-of-pocket costs may not apply or may be different. You'll generally pay any difference between the program's allowance and the billed amount for non-preferred providers.

Here's a breakdown of what you'll pay for a 30-day supply of covered drugs:

Keep in mind that the formulary and/or pharmacy network may change at any time. You'll receive notice when necessary.