Blue Rx, A Medicare Approved Part D Plan

Common Questions

 

Member Specific Common Questions

 

What is a Medicare Prescription Drug Plan?

Medicare Prescription Drug Plans provide coverage for prescription drugs and are offered by private insurance companies approved by Medicare, like Blue Cross and Blue Shield of Alabama.

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Why should I get Medicare prescription drug coverage?

Medicare prescription drug coverage provides peace of mind by protecting you from unexpected drug expenses. Once you become Medicare eligible, you are required to have creditable prescription drug coverage. Failure to enroll in a Part D plan when you become Medicare eligible will result in the assessment of a Late Enrollment Penalty (LEP). This penalty will be added to your Part D premium.

You can get more information on LEP here.

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Who is eligible for coverage?

To enroll in BlueRx, you must be a resident of Alabama or Tennessee. (If you are a Tennessee resident, please visit UTIC Insurance Company.) You must also be entitled to Medicare Part A and/or enrolled in Medicare Part B due to age or disability. Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed.

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What if I have more than one address?

If you have more than one address, you will need to provide your permanent physical address on your application. This address must match your primary address as listed with Social Security and Medicare. Your address will be used to determine your product eligibility and plan premiums. Failure to report your correct address can delay the processing of your application or result in the loss of coverage. If needed, you may also provide an alternate address (such as a Post Office Box) where you prefer to receive mailings.

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How much does BlueRx cost?

You can view available plans and rates here.

With all options, you are required to continue paying your Medicare Part B premium unless otherwise paid for by Medicaid or another third party. If you qualify for Low Income Subsidy, your premium may be reduced based on the level of subsidy for which you qualify.

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When can I make changes to my Prescription Drug Plan coverage?

You are allowed to make changes to your plan every year during the Annual Election Period (AEP). This is offered between October 15 and December 7, and all changes will be effective on January 1 of the following year.

You are also allowed to make changes if you are currently in your Initial Coverage Election Period (ICEP) or have a Special Election Period (SEP) due to an event such as qualifying for a Low Income Subsidy (LIS), losing health coverage through an employer, or moving out of your plan's service area.

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How do I enroll in BlueRx?

There are several ways to submit your enrollment application:

  • Online
  • Call us at 1-888-543-9212 (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From February 15 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
  • Attend a local meeting
  • Mail and application from the Enrollment Kit

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If I enroll in a new plan, when will my prior coverage end?

Your membership will end the last day of the month prior to when your new plan's coverage begins.

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What are my payment options?

Premiums are always due on the 1st of the month and are considered late if not received by the 10th.

There are several ways you can pay your plan premium:

  • Automatic monthly payment by E-Check, Credit Card, or Debit Card
  • Online at www.bcbsalmedicare.com after registering for myBlueCross
  • Over the telephone with Visa, MasterCard, Discover or E-Check
  • Automatic deduction from your monthly Social Security or Railroad Retirement Board benefits check
  • Mail a check
  • Set up online bill payment through your financial institution. Please be sure to include your contract number when setting up online bill payment.

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How do I set up automatic monthly payments?

Call Member Services to set up by telephone. All payments are drafted on the first business day of each month.

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What type of discounts will I receive during the coverage gap or donut hole?

Once the amount of drugs you have purchased for the year reaches $3,750 you will enter the coverage gap. BlueRx does not provide any coverage during the gap. However, you will receive a 65% discount on brand drugs if the manufacturer is contracted with CMS. For generic drugs, you will be discounted up to 56% of the plan allowable cost. After your total out-of-pocket cost reaches $5,000 you will enter the Catastrophic Coverage Phase. During this final phase, you will pay the greater of 5% coinsurance or a $3.35 copay for generic drugs/$8.35 copay for brand drugs. If you need additional assistance during the coverage gap, please contact your pharmacy for manufacturer discount programs, or call Social Security at 1-800-772-1213 to see if you qualify for extra help with your prescription drugs.

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What are star ratings?

CMS created the Five-Star Quality Rating System to help consumers compare plans more easily. They rate plan performances in different areas such as: customer service, member satisfaction, drug pricing, patient safety, etc. CMS requires Medicare Advantage and Part D Plans to include their star ratings in pre-enrollment packets. Medicare monitors all healthcare and prescription drug plans. The number of stars a plan receives gives you an overall rating for the plan as a whole, and Medicare hopes this rating will help you choose a plan that is right for you. View our plan star rating.

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How can I talk with a Blue Cross representative for more information?

  • Call us at 1-888-543-9212 (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From February 15 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
  • Sign up to attend a meeting with a local representative.

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How do I know if my prescription drugs are covered?

To see if a specific drug is covered under BlueRx, you may:

  • View formularies online: Option I and Option II
  • Look up your drug in our Find Drugs tool
  • Call the Member Services number on the back of your ID card (non-members may call 1-888-543-9212) (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From February 15 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
  • Request that a formulary be mailed to you

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My drug is not on your formulary. How can I get it added?

To request coverage for a medication not on the formulary, contact your physician and ask that a formulary exception request form be submitted on your behalf. This process can take up to 72 hours for a standard request. If your life, health or ability to regain maximum function may be at risk by waiting for a standard request decision, we will let you know our decision within 24 hours. This is considered an expedited request. If a non-formulary medication is approved to be added to your formulary, the copay will process as a Tier 4 for brand name drugs or Tier 2 for generic drugs.

You may also contact Member Services at 1-800-327-3998 (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From February 15 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day. 

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Can I fill my prescriptions by mail?

Yes, we offer the convenience of having your medications purchased through our mail order programs with AllianceRx Walgreens Prime. The benefits of using mail order include:

  • Saves Money by getting a 90-day supply for only 2 copays with free shipping
  • Saves Time since it's delivered to your home and no refills are needed for several months
  • Offers Convenience: You can order refills online, by mail or by phone

There are several ways to enroll in mail order. To register for these services please call or visit the website below:

AllianceRx Walgreens Prime website
1-800-731-3588
TTY: 711, 24 hours a day, 7 days a week

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Do I have drug coverage if I travel outside of Alabama?

Yes, you are still able to purchase your medications while traveling throughout the United States. BlueRx has a nationwide network of participating pharmacies that will allow you to purchase your medicine at the same copays as you would pay at a participating pharmacy in Alabama. To find a list of participating pharmacies, please visit the AllianceRx Walgreens Prime website, contact your Member Services Department, or call and request a pharmacy directory. If you use a pharmacy that is not participating, higher costs may apply.

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What is the difference between a Preferred Cost-Sharing Pharmacy and a Standard Cost-Sharing Pharmacy?

Preferred Cost-Sharing Pharmacies are pharmacies in our network where the Plan has negotiated lower cost sharing for your covered drugs and also for your long-term supply of covered drugs. Standard Cost-Sharing Pharmacies are also network pharmacies; however, you will pay a higher copay for your covered drugs and full price for a long-term supply of covered drugs. Both are network pharmacies and have a lower drug price than Out-of-Network Pharmacies.

Only Mail Order and Preferred Cost-Sharing Pharmacies can offer the lower copayments for a 90-day supply of approved drugs. Standard Cost-Sharing Pharmacies do not offer lower copayments for a 90-day supply of prescription drugs. 

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Member Specific Common Questions

 

Why am I receiving my Annual Notice of Change (ANOC) packet so soon?

Medicare requires all Medicare Advantage and Prescription Drug plans to notify members of the upcoming year's changes by September 30 of each calendar year.

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Will I receive a new ID card annually?

ID cards do not expire and will not be issued annually. If you need a new ID card, please contact Member Services at 1-800-327-3998 (TTY:711) 8 a.m. to 8 p.m., seven (7) days a week. From February 15 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.

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Can I keep my coverage if I move?

This plan is only offered to Alabama and Tennessee Residents. Medicare will allow you 60 days from the day you move to enroll in a Part D plan in your new state.

Please contact our Member Services Department to notify us of any changes to your physical address. Failure to report an address change can result in the loss of your coverage.

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If I qualify for Low Income Subsidy (LIS) this year, will I qualify again next year?

Please contact the Social Security Administration to see if you are required to reapply for Low Income Subsidy each year. There is no guarantee that you will automatically qualify each year, as the income criteria is subject to change. The Social Security Administration can be reached at 1-800-772-1213. If eligible for LIS, Social Security will send you a letter advising of your level of eligibility. Blue Cross and Blue Shield of Alabama will also be notified of any changes to your LIS eligibility.

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What is Best Available Evidence (BAE)?

Learn more about BAE and how to provide it.

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Why do I have to pay an extra Part D amount because of my income? (Part D Income Related Monthly Adjustment Amount- IRMAA)

If your modified adjusted gross income, as reported on your IRS tax return, is above a certain amount ($85,000 for individual, $170,000 for married couples), you will pay an extra amount in addition to your monthly plan premium.You may also hear this referred to as a surcharge, and can get more information on it here.If you have to pay an extra amount, the Social Security Administration (SSA) will send you a letter to advise what the extra amount is and how to pay it. 

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What if I decide to change the way I pay my premium?

Depending on the payment method selected, it can take up to three months for your new payment method to take effect. In the meantime, you are responsible for making sure your plan premium is paid on time. 

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How do I file a paper claim for prescription drugs?

Send your request for payment, along with receipts documenting the amount paid, to:
Part D Claims
PO Box 20970
Lehigh Valley, PA  18002-0970

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What are your Quality Assurance policies and procedures?

Blue Cross and Blue Shield of Alabama offers a number of standard Drug Utilization Management (DUM) services such as formulary management, prior authorization, quantity limits and step-therapy. These programs encourage safe, appropriate and cost-effective use of drugs. The goal of DUM is to monitor and prevent over- and under-utilization of prescription drugs while respecting the physician's prescribing authority. Using DUM, we also track and trend utilization, identify opportunities for improvement, and document and implement corrective actions when necessary. All policies are reviewed quarterly by an independent committee of pharmacists and physicians.

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What is the Medication Therapy Management (MTM) Program?

The MTM Program is a free service offered by your plan that can help you keep your medications on the right track.To learn more about the MTM Program go here.

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What is Prime Therapeutics LLC?

Prime Therapeutics is an independent company providing pharmacy benefit management services for Blue Cross and Blue Shield of Alabama BlueRx (PDP) members.

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Notices