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Brand and Generic Drugs

BlueRx (PDP) plans cover both Brand and Generic drugs. Generic drugs:

• Usually cost less than Brand drugs
• Have the same active-ingredient formula as Brand drugs
• Are rated by the Food and Drug Administration (FDA) to be as safe and effective as Brand drugs

Changes to the Formulary (Drug List)

The formulary, also called the Drug List, may change each month. There are many reasons why the formulary can change, such as:

• Generic drugs may become available
• New drugs could be developed
• A drug is no longer manufactured
• The Food and Drug Administration deems a drug to be unsafe

Requesting Exceptions to the Formulary

For information about requesting exceptions to our formulary, see our Appeals and Exceptions section. Members will be told 60 days ahead of time about changes in the formulary that affect them. You can also learn about changes:

• In the Drug Detail Section of the Drug Search results
• In the right-hand column of this Web site's member section, under Formulary Changes
• And in the Explanation of Benefits (EOB) that is mailed to members monthly

Drugs Not Covered by Any Prescription Drug Plan

Certain manufacturers did not agree to give a discount to Medicare and did not agree to participate in Medicare's discount program. Drugs from those manufacturers are not covered by any Medicare Prescription Drug Plan. However, most manufacturers did agree to participate in Medicare's discount program and their drugs are covered by Medicare. A list of participating manufacturers who agreed to provide discounts to Medicare and participate in Medicare's discount program can be found here. Simply click on Medicare Coverage Gap Discount Program – 2012 Labeler Code File and then select the most recent file, which will provide you with a list of participating manufacturers.

• If the manufacturer of your medication is not found on this list, your drugs may not be covered by Medicare.  Your pharmacist can assist you with identifying manufacturers of the drugs you take.  If your drugs are currently covered by our plan then the manufacturer is participating.
• No Medicare Prescription Drug Plan can make an exception to cover drugs made by non-participating manufacturers.
• If you need a drug that is made by a non-participating manufacturer, you can pay for it yourself; however, the costs will not count toward your Medicare prescription drug coverage out-of-pocket spending.
• BlueRx (PDP) covers many prescription drugs that may be right for your health condition; please talk to your doctor about using a prescription drug on Medi-CareFirst's list of covered drugs (formulary).

Learn More

The full list of covered prescription drugs and their general cost is called a formulary. If you have more questions about the formulary and how it works, please visit our Frequently Asked Questions.

If you would like to have a copy of the formulary sent to you when it is available, please call Claims Customer Service at 1-800-693-1434 (TTY: 1-800-693-0765), 24 hours a day/seven days a week.

For more information about the requirements surrounding prior authorization, please see our prior authorization criteria.