2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5(f)(a). FEP Medicare Prescription Drug Plan
Page 121

 

Benefit Description

Covered Medications and Supplies (cont.)

Standard Option - You Pay
Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year (no deductible)

Basic Option - You Pay

When Medicare Part B is primary and you are enrolled in the Medicare Prescription Drug Program, you pay the following:

Tier 1: Nothing for the purchase of up to a 90-day supply per calendar year

 

Benefits Description

Not covered:
 
  • Remicade, Renflexis, and Inflectra are not covered for prescriptions obtained from a retail pharmacy, Mail Service Prescription or through the Specialty Drug Program
     
  • 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
     
  • Insulin and diabetic supplies except when obtained from a retail pharmacy or through the Mail Service Prescription Drug Program, 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 retail pharmacy or through the Mail Service Prescription Drug Program

    Note: See Section 5(a) for our coverage of medical foods and nutritional supplements when administered by catheter or nasogastric tube.


Standard Option - You Pay
All charges

Basic Option - You Pay
All charges

 

Covered Medications and Supplies - continued on next page