We have a team of physicians and pharmacists—our Pharmacy and Therapeutics Committee (P&T)—who review our lists of covered medications (formularies) for safety and effectiveness. Based on recommendations from our P&T Committee, we occasionally make changes to the medications covered by our Formulary A list of certain drugs and their proper dosages. In some Medicare health plans, doctors must order or use only drugs listed on the health plan's formulary. .
Medications on the formulary may change for the following reasons:
New medications become available and may be added to the formulary.
Brand-name medications become available as generic. As generic medications become available, the corresponding brand-name medications may be removed from the formulary.
New pharmacy management programs such as prior authorization, step therapy, or quantity limits are adopted for select medications.
In some cases, if you are already taking a medication when its coverage changes, you will be exempt from those changes for the remainder of the plan year. The exception to this exemption is when a generic medication replaces a brand-name medication in the formulary. When that occurs, we will notify you, in writing, 60 days before the change takes effect. However, the notice period is waived when a medication is removed for safety reasons.
Use these resources to learn more:
2013 Medicare HMO Blue ValueRx/PlusRx Formulary
2013 Medicare PPO Blue ValueRx/PlusRx Formulary
Notice of Formulary Changes
We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify members who take the drug that it will be removed at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug.
If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.
The following links provide information about updates that have been made to our plans' formularies.
What if my drug is no longer covered?
If your medication is no longer covered by your Medicare Advantage plan, you have two options:
There are over 1,200 pharmacies in our Massachusetts network and over 61,900 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.
(The pharmacies listed in this network may differ from those in the Blue MedicareRx (PDP)* network. Please call Member Service at
1-800-200-4255 (TTY: 1-800-522-1254), 8:00 a.m. to 8:00 p.m. ET as follows: from February 15 through September 30, Monday through Friday, and from October 1 through February 14, seven days a week, or visit Blue MedicareRx (PDP) for more information.)