Common Questions for BlueRx (PDP) Members

 

 

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 may also change plans anytime during the year if you qualify for a special election period, such as by qualifying for a Low Income Subsidy (LIS) or moving out of your plan's service area.

 

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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.

 

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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 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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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 IandOption II
  • Call the Member Services number on the back of your ID card (non-members may call 1-888-543-9212) 
  • 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 aformulary 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.

 

You may also contact Member Services at 1-800-327-3998, 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. If a non-formulary medication is approved to be added to your formulary, the copay will process as a tier 4 non-preferred medication.

 

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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. Standard Cost-Sharing, Preferred Cost-Sharing and Mail Order Pharmacies can be found in the 2016 Pharmacy Directory.

 

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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 14429
Lexington, KY  40512-4429

 

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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 Prime Mail and Walgreens. 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 websites below:

Prime Mail
Prime Mail Website
1-800-731-3588
TTY: 711, 24 hours a day, 7 days a week

Walgreens
Walgreens Website
1-800-489-2197
TTY: 1-800-573-1833, 24 hours a day, 7 days a week

 

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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. Click here to learn more about the MTM Program.

 

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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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