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Cover Page and Inside Cover
Table of Contents
Introduction/Plain Language/Advisory
PSHB Facts
Section 1
Section 2
Section 3
Section 4
Section 5
5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
5(d). Emergency Services/Accidents
5(e). Mental Health and Substance Use Disorder Benefits
5(f). Prescription Drug Benefits
5(f)(a). FEP Medicare Prescription Drug Plan
5(g). Dental Benefits
5(h). Wellness and Other Special Features
5(i). Services, Drugs, and Supplies Provided Overseas
Non-PSHB Benefits Available to Plan Members
Section 6
Section 7
Section 8
Section 8(a)
Section 9
Section 10
Index
Summary of Benefits – FEP Blue Focus
2025 Rate Information
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Blue Cross Blue Shield Federal Employee Program logo
 
 

 

2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits
Covered Medications and Supplies

 

Benefits Description

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
       
  • Brand-name medications available by prescription:
     
    • Nicotrol cartridge inhaler
       
    • Nicotrol NS spray 10 mg/ml
       
  • 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
 

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