2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(f). Prescription Drug Benefits
Page 98
Section 5(f). Prescription Drug Benefits
Page 98
Benefits Description
Covered Medications and Supplies (cont.)
The following medications are covered through this program:
Notes:
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Covered Medications and Supplies (cont.)
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.
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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
- Insulin and diabetic supplies except when obtained from a Preferred retail pharmacy 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.
You Pay
All charges
Covered Medications and Supplies - continued on next page