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Medication Look-up

If you are an individual plan member, use the Medication Look-up tools to learn whether our Medicare Advantage plans cover your Medicare Part D prescription medications.

In some cases, retail drugs and supplies are covered under your Part B of Original Medicare medical benefit (e.g. lancets, test strips). By law, certain types of drugs or categories of drugs are not covered under Medicare Part D.

The formulary was last updated on: 4/2014. The formulary may change during the year. To get the most recent list of drugs we cover, contact us at 1-800-200-4255 (TTY/TDD users call 1-800-522-1254) February 15 through October 14, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, and from October 15 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week. Or visit www.bluecrossma.com/medicare.

Instructions
First select a plan name. Then enter medication details by entering the first three letters of your medication name and/or by selecting the Therapeutic class from the drop down list.


Search Formulary

If your eligible Medicare Part D medication is not on the list, you may ask us to cover that medication by requesting a formulary exception. Visit the Appeals & Grievances section for more information.

For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. This ensures that our members use these drugs in a safe way. Visit the Prior Authorization, Step Therapy, and Quality Care Dosing Requirements section for more information.

For questions call Member Services at 1-800-200-4255 (TTY/TDD 1-800-522-1254) February 15 through September 30, 8:00 a.m. To 8:00 p.m. ET, Monday through Friday, and from October 1 through February 14, 8:00 a.m. To 8:00 p.m. ET, seven days a week.

Blue Cross Blue Shield of Massachusetts Medicare Advantage Plans cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Your Medicare Part D prescription benefit is a 5-tier structure. For more information about tiers, please see your summary of benefits. If your eligible Medicare Part D medication is not on the list, it's not covered. You may ask us to cover a Medicare Part D medication not listed on our formulary by requesting a formulary exception to waive coverage restrictions or limits on your medication. Visit the Appeals & Grievances section for more information.

Also, displayed are some medications and supplies covered under your Part B of Original Medicare medical benefit. These medications and supplies are available at network retail pharmacies. However, they do not qualify for exception requests, extra help on drug costs,transition fills, or accumulate toward your total out of pocket costs to bring you through the coverage gap faster like drugs covered under your Medicare prescription drug benefit. You pay nothing for these drugs and supplies covered under your Original Medicare medical benefit.