Blue Cross and Blue Shield of Florida
Blue Cross and Blue Shield of Florida



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BlueSelect® FAQs

 

What is a formulary?

A formulary is a list of prescription medications covered under the pharmacy program.

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BlueSelect has a 2-tier Closed Formulary. What does this mean?

The BlueSelect Formulary includes two lists of covered medications, called Tier 1 and Tier 2.

  • Tier 1 is the lowest cost. It is a list of the generic medications that are covered under your plan. Most generic medications are covered, so even if your medication is not on the list, it may still be covered unless it is specifically excluded in your benefits.
  • Tier 2 is higher cost. It is a list of brand name drugs that are covered under your plan. It is a closed formulary, so that means brand name medications not on the list will not be covered and you will be responsible for the entire cost of the medication.

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What are the differences between brand and generic drugs?

The Food and Drug Administration (FDA) has deemed that generic drugs are therapeutically equivalent to brand-name drugs. Generic drugs have the same active ingredients, strength, dosage form, safety, quality and performance as their brand counterparts. You receive the greatest cost savings by selecting generic instead of brand medications.

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What if my medication is not listed in the BlueSelect formulary? Are there any exceptions?

If you are taking a generic medication that is not listed in the formulary, it will still be covered unless it is specifically excluded in your benefits.

Brand medications not listed in the formulary are not covered and you will be responsible for the entire cost of the medication. You should check with your doctor or health care provider to see if your medical condition can be treated with a medication that is listed on the formulary. If your condition cannot be treated with a medication listed on the formulary, your doctor can submit a Formulary Exception Request . If approved, the medication will be covered based on your benefits for brand medications. Once an exception request is approved, it is valid for the remainder of the plan year, as long as your physician continues to prescribe the drug for you and it continues to be safe and effective for treating your condition.

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What if my doctor or I choose to use a brand name medication when a generic equivalent is available?

The BlueSelect formulary list contains all generics and selected brand drugs. In most cases, the brand versions of drugs available generically are not covered. In cases where a brand version of a generic drug is covered and requested, you will be required to pay the brand deductible co-pay and/or coinsurance, plus the cost difference between the brand and generic drug. This applies whether it is your decision or your doctor's decision to use the brand version.

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What are specialty drugs?

Specialty Drugs are generally higher-cost drugs that require special handling, storage, training, distribution, and/or management of the therapy. The BlueSelect Formulary includes a list of covered specialty drugs.


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When do I need to go to a Retail Pharmacy vs. a Specialty Pharmacy?

You can go to a retail pharmacy for most of your prescription medication needs. However, if you need a specialty drug, you should use a participating BlueSelect Specialty Pharmacy to get your specialty drugs at the lowest cost possible. Check the Medication Guide to find out if your medication is a specialty drug. Then check our Provider Directory to locate a participating BlueSelect Specialty Pharmacy. Look for the words "specialty pharmacy" by the name of the pharmacy. You may want to call ahead to verify that they have the drug you need.


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What can I do to save the most money on my prescriptions?


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Are there any special requirements or limits on certain medications that I should know about?

Some medications may require previous treatment with other medications or may have limits on the dosage or quantity that will be covered each month. To find out more about these important patient safety and quality programs, view the Responsible Steps section of the BlueSelect Medication Guide.


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What is Prior Authorization and how do I know if I need it?

BCBSF requires you to get prior authorization for certain drugs in order to determine coverage. This means that you will need to get approval from BCBSF before you fill your prescription. If you don't get prior approval, the drug may not be covered under your BlueSelect Rx plan. Medications that require prior authorization are listed in the BlueSelect Medication Guide with the letters "PA" beside them.


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How do I fill a prescription?

  1. Find a BlueSelect participating pharmacy near you.
    • In Step 1: click on Retail Pharmacies or Specialty Pharmacies (whichever applies)
    • In Step 2: Enter a pharmacy name or simply choose "BlueSelect " under "Plan" options and enter your city name or zip code. Then click Search.
  2. Take your prescription(s) to the BlueSelect participating pharmacy of your choice and show them your BlueSelect ID card.
  3. When your prescription is ready, simply pay your portion of the pharmacy deductible, copay or coinsurance, whichever applies. That's all there is to it. You don't have to file any receipts or paperwork when you use a participating pharmacy.

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I went to a BlueSelect participating retail pharmacy, but forgot my ID card. I had to pay the full cost of the medication. Can I be reimbursed?

You may submit a claim form to be reimbursed for covered prescription drugs. Reimbursement will be made based on the benefits of your plan. Simply complete the claim form, attach your receipt and mail it to the address indicated on the form. Remember to keep a copy for your records.


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What happens if I fill my prescription at a pharmacy that does NOT participate in the BlueSelect pharmacy network?

You may have to pay the entire cost of the drug and then submit a claim form to be reimbursed. You will not be reimbursed for the full cost of the drug. Reimbursement for covered prescription drugs and supplies will be based on our Non-Participating Pharmacy Allowance minus the out-of-network deductible, copays or coinsurance that apply.


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What should I do if I'm traveling outside the state of Florida and need a prescription filled?

You may use the Blue Cross and Blue Shield National Pharmacy Network to fill your prescription. For help finding a participating pharmacy, simply call the customer service number on your ID card.

If you use a non-participating pharmacy, you may have to pay the entire cost of the drug and then submit a claim form to be reimbursed. You will not be reimbursed for the full cost of the drug. Reimbursement for covered prescription drugs and supplies will be based on our Non-Participating Pharmacy Allowance minus the out-of-network deductible, copays or coinsurance that apply.

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