Common Questions - Bluerxalatenn
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- What is a Medicare Prescription Drug Plan?
- Why should I get Medicare prescription drug coverage?
- Who is eligible for coverage?
- What if I have more than one address?
- How much does BlueRx cost?
- When can I make changes to my Prescription Drug Plan coverage?
- How do I enroll in BlueRx?
- If I enroll in a new plan, when will my prior coverage end?
- What are my payment options?
- What type of discounts will I receive during the coverage gap or donut hole?
- What are star ratings?
- How can I talk with a UTIC representative for more information?
- My drug is not on your formulary. How can I get it added?
- How do I know if my prescription drugs are covered?
- Can I fill my prescriptions by mail?
- Do I have drug coverage if I travel outside of Tennessee?
- What is the difference between a Preferred Cost-Sharing Pharmacy and a Standard Cost-Sharing Pharmacy?
- What is the Consumer Assessments of Health Plans (CAHPS) Survey?
Medicare Prescription Drug Plans provide coverage for prescription drugs and are offered by private insurance companies approved by Medicare, like UTIC Insurance Company.
Medicare prescription drug coverage provides peace of mind by protecting you from unexpected drug expenses. Once you become Medicare eligible, you are required to have creditable prescription drug coverage. Failure to enroll in a Part D plan when you become Medicare eligible will result in the assessment of a Late Enrollment Penalty (LEP). This penalty will be added to your Part D premium.
To enroll in BlueRx you must be a resident of Tennessee. You must also be entitled to Medicare Part A and/or enrolled in Medicare Part B due to age or disability. Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed.
If you have more than one address, you will need to provide your permanent physical address on your application. This address must match your primary address as listed with Social Security and Medicare. Your address will be used to determine your product eligibility and plan premiums. Failure to report your correct address can delay the processing of your application or result in the loss of coverage. If needed, you may also provide an alternate address (such as a Post Office Box) where you prefer to receive mailings.
If you qualify for Low Income Subsidy, your premium may be reduced based on the level of subsidy for which you qualify.
You are allowed to make changes to your plan every year during the Annual Election Period (AEP). This is offered between October 15 and December 7, and all changes will be effective on January 1 of the following year.
Other times that you are allowed to make changes to your coverage outside of AEP are:
- Initial Coverage Election Period (ICEP) - three months before you Medicare eligibility effective date, the month of your Medicare eligibility date, and three months after.
- Special Election Period (SEP) - You can change plans anytime during the year if you gain, lose, or have a change in your dual eligible or Low Income Subsidy status. You are also allowed to make elections within 60 days of the day you lose coverage with your employer and within 60 days of the day you move into a new coverage area.
There are several ways to submit your enrollment application:
- Online application
- Call us at 1-888-543-9212 (TTY 711) from 8 a.m. to 8 p.m., 7 days a week
- Mail us an application or request an Enrollment Kit Packet to be mailed to your house.
Your membership will end the last day of the month prior to when your new plan's coverage begins.
Premiums are always due on the 1st of the month and are considered late if not received by the 10th.
There are several ways you can pay your plan premium:
- Automatic monthly draft payment by E-Check, Credit Card, or Debit Card
- Over the telephone with Visa, MasterCard, Discover or E-Check
- Automatic deduction from your monthly Social Security or Railroad Retirement Board benefits check
- Mail a check
- Set up online bill payment through your financial institution. Please be sure to include your contract number when setting up online bill payment.
Once the amount of drugs you have purchased for the year reaches $4,020 you will enter the coverage gap. BlueRx does not provide any coverage during the gap. However, you will receive a 75% discount on brand drugs if the manufacturer is contracted with CMS. For generic drugs, you will be discounted up to 75% of the plan allowable cost. After your total out-of-pocket cost reaches $6,350 you will enter the Catastrophic Coverage Phase. During this final phase, you will pay the greater of 5% coinsurance or a $3.60 copay for generic drugs/$8.95 copay for brand drugs. If you need additional assistance during the coverage gap, please contact your pharmacy for manufacturer discount programs, or call Social Security at 1-800-772-1213 to see if you qualify for extra help with your prescription drugs.
The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure the experiences Medicare beneficiaries have with their health and drug plans and health care system — the Star Rating Program. Health and drug plans are rated on a scale of 1 to 5 stars, with 5 being the highest.
The Star Rating Program is intended to:
- Raise the quality of care for Medicare beneficiaries
- Strengthen beneficiary protections
- Help people compare health and drug plans more easily
View the BlueRx Star rating.
- Call us at 1-888-543-9212 (TTY 711) from 8 a.m. to 8 p.m., 7 days a week.
To see if a specific drug is covered under BlueRx, you may:
- View formularies online: Essential, Enhanced or Enhanced Plus
- Call the Member Services number on the back of your ID card (non-members may call 1-855-617-6761) (TTY 711) 8 a.m. to 8 p.m., seven (7) days a week. From April 1 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
- Request that a formulary be mailed to you
To request coverage for a medication not on the formulary, contact your physician and ask that a formulary exception request form be submitted on your behalf. This process can take up to 72 hours for standard request. If your life, health or ability to regain maximum function may be at risk by waiting for a standard request decision, we will let you know our decision within 24 hours. This is considered an expedited request. If a non-formulary medication is approved to be added to your formulary, the copay will process as a Tier 4 for brand name drugs or Tier 2 for generic drugs.
You may also contact Member Services at 1-855-617-6761 (TTY:711) 8 a.m. to 8 p.m., seven (7) days a week. From April 1 to September 30, on weekends and holidays you may be required to leave a message. Calls will be returned the next business day.
Yes, we offer the convenience of having your medications purchased through our mail order programs with AllianceRx Walgreens Prime. The benefits of using mail order include:
- Saves Money by getting a 90-day supply for only 2 copays with free shipping
- Saves Time since it's delivered to your home and no refills are needed for several months
- Offers Convenience: You can order refills online, by mail or by phone
There are several ways to enroll in mail order. To register for these services please call or visit the website below:
AllianceRx Walgreens Prime website
TTY: 711, 24 hours a day, 7 days a week
Yes, you are still able to purchase your medications while traveling throughout the United States. BlueRx has a nationwide network of participating pharmacies that will allow you to purchase your medicine at the same copays as you would pay at a participating pharmacy in Tennessee. To find a list of participating pharmacies, please visit the Prime website, contact your Member Services Department, or call and request a pharmacy directory. If you use a pharmacy that is not participating, higher costs may apply.
What is the difference between a Preferred Cost-Sharing Pharmacy and a Standard Cost-Sharing Pharmacy?
Preferred Cost-Sharing Pharmacies are pharmacies in our network where the Plan has negotiated lower cost sharing for your covered drugs and also for your long-term supply of covered drugs. Standard Cost-Sharing Pharmacies are also network pharmacies; however, you will pay a higher copay for your covered drugs and full price for a long-term supply of covered drugs. Both are network pharmacies and have a lower drug price than out-of-network pharmacies.
Only Mail Order and Preferred Pharmacies can offer the lower copayments for a 90-day supply of approved drugs. Standard Cost Sharing Pharmacies do not offer lower copayments for a 90-day supply of prescription drugs.
CMS collects information about Medicare beneficiaries’ experiences with, and ratings of, Medicare Advantage (MA-only) plans, Medicare Advantage Prescription Drug (MA-PD) plans, and stand-alone Medicare Prescription Drug Plans (PDP) by participating in the Consumer Assessments of Health Plans Study (CAHPS) Survey. To review the CAHPS survey results please visit www.MA-PDPCAHPS.org