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Welcome to Blue Cross MedicareRx (PDP)

Whether you’re new to Medicare or just to your plan, here are some tips to make the transition smooth. Feeling a little nervous about your new plan? We understand. Your Medicare plan may be new to you now, but soon you’ll get to know it and be comfortable with it. You may even like it better than your previous health care plan. We hope to answer your basic questions here.

If you need more information or just want a little help understanding your benefits or the Medicare rules, call the number on the back of your member ID card.

We Stay in Touch

Because we care about your well-being and want you to get the most from your Blue Cross MedicareRx plan, we stay in touch with you throughout the year.

Email Alerts

We’d like to have your email address to send you communications about health plan benefits and programs throughout the year. We never share your email address outside the plan. You can always opt out or ask us to stop sending you emails.

Annual Notice of Change (ANOC)

You will receive an Annual Notice of Change in October. This notice outlines any expected premium and/or benefit changes for next year. These changes will go into effect January 1 of the following calendar year. Review this document carefully.

Explanation of Benefits (EOB)

An Explanation of Benefits is a statement that shows details of your pharmacy expenses and how your benefits were applied to cover those expenses. You will receive an EOB whenever a pharmacy claim has been processed. This statement is not a bill. It simply details what you have paid and indicates the level of benefits you’ve used. Review these statements to be sure they are correct. If you think there are errors, please contact us. If you think you are the victim of fraud, report it immediately.

The Drug Formulary May Be Different

Blue Cross MedicareRx plans cover a broad range of prescription drugs. The formulary may be different from what you’re used to, and it can change. The most current formulary is always available online. Share the formulary with your doctor and talk about the drugs you take now. You may be able to save money by choosing generic drugs. Ask if this is an option for you.

Drugs Are Placed Into Tiers

In prescription drug plans, drugs are placed into tiers. The costs for drugs in each tier are different. Generally, drugs on lower-number tiers cost less. The tiers are:

  • Tier 1 – Preferred Generic Drugs
  • Tier 2 – Generic Drugs
  • Tier 3 – Preferred Brand Drugs
  • Tier 4 – Non-Preferred Drugs
  • Tier 5 – Specialty Drugs

Prior Authorization, Step Therapy and Quantity Limits

Please read the formulary for more information about these rules and exceptions, or visit the Prior Authorization/Utilization Management page for more information. 

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Last Updated: Aug. 02, 2023