2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f)(a). FEP Medicare Prescription Drug Program
Page 99
Section 5(f)(a). FEP Medicare Prescription Drug Program
Page 99
Benefits Description
Covered Medications and Supplies (cont.)
You Pay
All charges
Covered Medications and Supplies (cont.)
- Insulin and diabetic supplies except when obtained from a Preferred retail pharmacy or except when Medicare Part B is primary or you are enrolled in the FEP Medicare Prescription Drug Program. See Section 5(a).
- Medications and orally taken nutritional supplements that do not require a prescription under Federal law even if your doctor prescribes them or if a prescription is required under your state law
Note: See previous benefits in this section for our coverage of medications recommended under the Affordable Care Act and for smoking and tobacco cessation medications.
- Medical foods administered orally are not covered if not obtained at a Preferred retail pharmacy
Note: See Section 5(a) for our coverage of medical foods when administered by catheter or nasogastric tube.
- Products and foods other than liquid formulas or powders mixed to become formulas; foods and formulas readily available in a retail environment and marketed for persons without medical conditions; low-protein modified foods (e.g., pastas, breads, rice, sauces and baking mixes); nutritional supplements, energy products; and similar items
Note: See Section 5(a) for our coverage of medical foods and nutritional supplements when administered by catheter or nasogastric tube.
- Infant formula other than previously described in this section and in Section 5(a)
- Drugs not listed on the formulary or preferred drug list
- Brand name opioids
- Remicade, Renflexis, and Inflectra are not covered for prescriptions obtained from a Preferred retail pharmacy, or through the Specialty Drug Pharmacy Program
- Drugs for which prior approval has been denied or not obtained
- Drugs and supplies related to sexual dysfunction or sexual inadequacy
- Drugs and covered-drug-related supplies for the treatment of gender dysphoria if not obtained from a Preferred retail pharmacy or the Specialty Drug Pharmacy Program as previously described in this section
- Drugs purchased through the mail or internet from pharmacies inside or outside the United States by members located in the United States
- Over-the-counter (OTC) contraceptive drugs and devices, except as previously described in this section
- Drugs used to terminate pregnancy
- Sublingual allergy desensitization drugs, except as described in Section 5(a)
You Pay
All charges