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Drug coverage
Prescription drug plans cover only those drugs eligible for coverage under Medicare Part D.
These plans come with a formulary, or a list of covered prescription drugs, which are grouped into tiers. Some drugs may be listed in more than one tier if they are available as both generic and brand-name or if there are multiple strengths for the drug.
Medicare Part D plans do not cover certain drugs that are excluded by law, such as over-the-counter medications and prescription vitamins.
Help with paying your costs
Some members may qualify for the Part D Extra Help Program and Low-Income Subsidy.
If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly plan premium as a member of our plan.
Your pharmacy network
Blue Medicare Advantage℠ and Blue Medicare Rx℠ members can go to any pharmacy in our network to pick up a prescription drug. Our network includes retail, long-term care, home infusion, Indian Health Service / Tribal / Urban Indian Health Program (I / T / U), specialty, and mail-order pharmacies.
Your costs for some drugs may be less at pharmacies that offer preferred cost-sharing. This is known as our Preferred Pharmacy network. Some pharmacies in our preferred network are listed below.
Preferred Retail Pharmacies
- Harris Teeter
- Sam's Club
- Walgreens
- Walmart
- Others
Experience Health Medicare Advantage℠ (HMO) and Healthy Blue + Medicare℠ (HMO-POS D-SNP) members do not have a Preferred Pharmacy network. Members of these plans may go to any pharmacy in their network.
Preferred Mail Order Pharmacies
- Express Scripts Pharmacy (ESI)
- Walgreens Mail Service
Learn more about prescription drugs by mail.
Learn more about your coverage
Find out more about prescription drug coverage, including information on benefits, how to read your explanation of benefits (EOB), drug category tiers, and other important details.
Disclosures:
Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal.
Blue Cross and Blue Shield of North Carolina Senior Health DBA Blue Cross and Blue Shield of North Carolina is an HMO-POS D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal.
Blue Medicare Supplement plans offered: Plan A: BMS A, 1/24, Plan G: BMS G, 1/24, Plan HI DED G: BMS HDG, 1/24, Plan K: BMS K, 1/24, Plan N: BMS N, 1/24.
Blue Medicare Supplement is not endorsed by or affiliated with the United States Government or the federal Medicare program.
The federal government requires all Medicare Advantage members to continue paying their Part B premium each month.
Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, sexual orientation or source of payment. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
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Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers several decision-support tools to aid you in making decisions around your health care experience. These tools are offered for your convenience and should be used only as reference tools. You should consult your own legal counsel, tax advisor or personal physician as applicable throughout your health care experience.
Out-of-network / non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
The Blue FlexCard is issued by Stride Bank, N.A., Member FDIC, pursuant to license by Mastercard International. Stride Bank is an independent company offering debit card services and is solely responsible for its products.
Blue Cross NC contracts with independent companies to provide supplemental benefits. Those companies are responsible for the services they provide. They do not provide Blue Cross or Blue Shield products or services. Marks and trade names are property of their respective owners.
Change Healthcare is an independent company providing revenue and payment cycle management on behalf of Blue Cross and Blue Shield of North Carolina.
FitOn Health is an independent company providing health and fitness services on behalf of Blue Cross and Blue Shield of North Carolina.
CareLinx is an independent company providing in-home care solutions on behalf of Blue Cross and Blue Shield of North Carolina.
TruHearing is an independent company providing hearing health and hearing aids on behalf of Blue Cross and Blue Shield of North Carolina.
Current as of 07/12/2024 | Y0079_12997_M CMS Accepted 11132024 | U36079, 6/24
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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