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

 

Benefits Description
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.
     
  • Medical foods administered orally are not covered if not obtained at a Preferred retail pharmacy

    Note: See Section 5(a) for our coverage of medical foods when administered by catheter or nasogastric tube.
     
  • Products and foods other than liquid formulas or powders mixed to become formulas; foods and formulas readily available in a retail environment and marketed for persons without medical conditions; low-protein modified foods (e.g., pastas, breads, rice, sauces and baking mixes); nutritional supplements, energy products; and similar items

    Note: See Section 5(a) for our coverage of medical foods and nutritional supplements when administered by catheter or nasogastric tube.
     
  • Infant formula other than previously described in this section and in Section 5(a)
     
  • Drugs not listed on the formulary or preferred drug list
     
  • Brand name opioids
     
  • Remicade, Renflexis, and Inflectra are not covered for prescriptions obtained from a Preferred retail pharmacy, or through the Specialty Drug Pharmacy Program
     
  • Drugs for which prior approval has been denied or not obtained
     
  • Drugs and supplies related to sexual dysfunction or sexual inadequacy
     
  • Drugs and covered-drug-related supplies for the treatment of gender dysphoria if not obtained from a Preferred retail pharmacy or the Specialty Drug Pharmacy Program as previously described in this section
  • Drugs purchased through the mail or internet from pharmacies inside or outside the United States by members located in the United States
     
  • Over-the-counter (OTC) contraceptive drugs and devices, except as previously described in this section
     
  • Drugs used to terminate pregnancy
     
  • Sublingual allergy desensitization drugs, except as described in Section 5(a)

You Pay
All charges