Find Drugs
Many drugs are covered on the BlueRx formulary. Check to see if your drug is covered by using the online drug guide or viewing the complete drug list for each plan:
Search the Part D Prescription Drug Guide
- BlueRx Search Drugs
- View the Entire Drug List for the Essential Plan
- View the Entire Drug List for the Enhanced Plan
- View the Entire Drug List for the Enhanced Plus Plan
- 2023 BlueRx Transition Guidance
If your drug is not covered and you think it should be, you may ask BlueRx to make an exception to the coverage rules.
- BlueRx Coverage Determination
Note: BlueRx may make changes to its formulary. Members usually receive notification of these changes 60 days in advance.
Click here for ways to ensure you are paying the least amount for your prescriptions with Rx Savings Solutions.
Find a Pharmacy
You can choose from any of BlueRx's participating pharmacies. We have more than 63,000 in our network, including retail, mail-order, home infusion, long-term care (LTC), and Indian/Tribal/Urban (I/T/U) pharmacies. BlueRx has a contract with pharmacies that exceeds CMS requirements for pharmacy access.
Drugs received from an out-of-network pharmacy may be covered in special circumstances, for instance, while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from BlueRx.
- BlueRx Pharmacy
- More Information about BlueRx's Essential Pharmacy Directory
- More Information about BlueRx's Enhanced/Enhanced Plus Pharmacy Directory
The mail-order program offers you the convenience of mail-order delivery of your prescription drugs.
- Learn more about the mail-order program
Notices
PEEHIP's Pharmacy Benefits are administered by Express Scripts for PEEHIP's Active Members and Non-Medicare-Eligible Retirees who are enrolled in the PEEHIP Blue Cross Blue Shield Group #14000 Hospital Medical Plan.
- Express Scripts Contact Information
- Information about prescription drugs and medications is located in the PEEHIP Hospital Medical Plan section of your Member Handbook (Active Members and Non-Medicare-Eligible Retirees).
- Express Scripts Prescription Drug Lookup and Pharmacy Locator--coming soon!
- Express Scripts administers PEEHIP's specialty drug pharmacy program. Click here for a list of all in-network specialty pharmacies.
Formulary Drug List
Other Pharmacy Benefit Information
- Express Scripts At-Home COVID Test Reimbursement Form
- VIVA Health At-Home COVID Test Reimbursement Form
- Express Scripts Prescription Drug Reimbursement Form
- Flu Shots
- PEEHIP's Pharmacy Benefits are administered by Humana for PEEHIP's Medicare-eligible Retirees.
Prescription Benefit Copays Administered by Express Scripts
Tier 1 - Generic:
- $6 copay (1-30 day supply)
- $12 copay (31-90 day supply)
Tier 2 - Formulary (preferred brand name):
- $40 copay (1-30 day supply)
- $80 copay (31-60 day supply)
- $120 copay (61-90 day supply)
Tier 3 - Non-formulary (non-preferred brand name):
- $60 copay (1-30 day supply)
- $120 copay (31-60 day supply)
- $180 copay (61-90 day supply)
Tier 4 - Specialty Drugs
- 20% coinsurance per prescription, with a minimum of $100 copay and maximum of $150 copay (1-30 day supply)
- Days supplies greater than 30 are not allowed for specialty drugs (31-60 day supply)
- Days supplies greater than 30 are not allowed for specialty drugs (61-90 day supply)
Flexible Content Medicare Prescription Drug plans are offered by private health insurance companies and cover your prescription drug costs for covered medications. Prescription Drug Coverage (Part D)
You can choose to receive this coverage in addition to:
- Original Medicare (Part A and Part B)
- Original Medicare (Part A and Part B) with a Medigap Plan
Part D coverage is generally included in most Medicare Advantage (Part C) plans.
Costs
Most Part D plans require a monthly premium. |
Some plans have deductibles. |
Many Part D plans require that you pay a fixed copayment each time you fill a prescription. |
Some Part D plans require that you pay a percentage (coinsurance) of a medication’s cost every time you fill a prescription. |
Although plan designs can vary, most Medicare Part D plans have a cost sharing component commonly known as a coverage gap or “donut hole.” The coverage gap is a temporary limit where you are responsible for all of your drug costs until you reach the plan’s annual out-of-pocket limit. After you reach that limit, you will pay only a small share of your prescription costs for the remainder of the year. |
Limits and Considerations
Limits
Most Part D plans have “formularies,” which are lists of covered prescription drugs. Part D plans also have networks of approved pharmacies in your area.
Things to Consider
- Costs for Part D plans can vary, so choose a plan that meets your needs and budget.
- Part D insurance premiums may change each year. You will be notified of these changes in the fall prior to the annual Open Enrollment Period.
- Medicare Part D has a low-income subsidy program, and Medicare beneficiaries may qualify for financial assistance with the cost of their medications based upon their income and assets.
Initial Enrollment Period
The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Parts A or B, you can select other coverage options like a Prescription Drug Coverage (Part D) plan from approved private insurers. After this period has ended, you can add or change your coverage during the Open Enrollment Period.
How to Enroll
You must be entitled to Part A or enrolled in Part B, and you must live in the designated geography of the plan you want to enroll in before joining a Medicare Part D plan. Contact your local Blue Cross Blue Shield company for help choosing a Medicare Part D plan and getting enrolled.
Open Enrollment Period
October 15 through December 7
Open Enrollment runs from October 15 through December 7 and it provides an annual opportunity for Medicare-eligible consumers to review and make changes to their Medicare coverage. This includes the opportunity to select or make changes to Prescription Drug Coverage (Part D). However, if you elect to receive Part D coverage after your Initial Enrollment Period window closes, a late enrollment penalty may be added to your premium.
Download the Medicare Advantage (Part C) and Prescription Drug Plans (Part D) guide to find the coverage options offered by your local Blue Cross Blue Shield company.