2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f)(a). FEP Medicare Prescription Drug Program
Page 98
Section 5(f)(a). FEP Medicare Prescription Drug Program
Page 98
Benefits Description
Covered Medications and Supplies (cont.)
Smoking and Tobacco Cessation Medications
If you are a covered member, you may be eligible to obtain specific prescription generic and brand-name smoking and tobacco cessation medications at no charge. Additionally, you may be eligible to obtain over-the-counter (OTC) smoking and tobacco cessation medications, prescribed by your physician, at no charge. These benefits are only available when you use a Preferred retail pharmacy. The Quit Plan is not required for those covered under the FEP Medicare Prescription Drug Program.
Note: There may be age-restrictions based on U.S. FDA guidelines for these medications.
The following medications are covered through this program:
Notes:
You Pay
Preferred retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Covered Medications and Supplies (cont.)
Smoking and Tobacco Cessation Medications
If you are a covered member, you may be eligible to obtain specific prescription generic and brand-name smoking and tobacco cessation medications at no charge. Additionally, you may be eligible to obtain over-the-counter (OTC) smoking and tobacco cessation medications, prescribed by your physician, at no charge. These benefits are only available when you use a Preferred retail pharmacy. The Quit Plan is not required for those covered under the FEP Medicare Prescription Drug Program.
Note: There may be age-restrictions based on U.S. FDA guidelines for these medications.
The following medications are covered through this program:
- Generic medications available by prescription:
- Bupropion ER 150 mg tablet
- Bupropion SR 150 mg tablet
- Varenicline 0.5 mg tablets
- Varenicline 1 mg tablets
- Varenicline starting pack
- Bupropion ER 150 mg tablet
- Brand-name medications available by prescription:
- Nicotrol cartridge inhaler
- Nicotrol NS spray 10 mg/ml
- Nicotrol cartridge inhaler
- Over-the-counter (OTC) medications
Notes:
- To receive benefits for over-the-counter (OTC) smoking and tobacco cessation medications, you must have a physician’s prescription for each OTC medication that must be filled by a pharmacist at a Preferred retail pharmacy.
- Regular prescription drug benefits will apply to purchases of smoking and tobacco cessation medications not meeting these criteria. Benefits are not available for over-the-counter (OTC) smoking and tobacco cessation medications except as described above.
- See Section 5(a) for our coverage of smoking and tobacco cessation treatment, counseling, and classes.
You Pay
Preferred retail pharmacy: Nothing (no deductible)
Non-preferred retail pharmacy: You pay all charges
Benefits Description
Not covered:
You Pay
All charges
Not covered:
- Drugs and supplies purchased from a Non-preferred pharmacy
- Medical supplies such as dressings and antiseptics
- Drugs and supplies for cosmetic purposes
- Supplies for weight loss
- Drugs for orthodontic care, dental implants, and periodontal disease
- Drugs used in conjunction with non-covered assisted reproductive technology (ART) and assisted insemination procedures
- Drugs used in conjunction with IVF that exceed the covered 3 per year annual cycle limitation described in this section
You Pay
All charges
Covered Medications and Supplies - continued on next page