Eligibility for Group MedicareBlue Rx
You are eligible to enroll in Group MedicareBlue Rx if you:
- Are entitled to Medicare Part A and/or enrolled in Medicare Part B
- Live in the plan's service area
- Are identified as an eligible plan participant by your employer
While enrolled in Group MedicareBlue Rx, you must continue to pay your Medicare Part B premium and Medicare Part A (if applicable), if not otherwise paid for by Medicaid or another third party. You can only enroll in one Part D plan at a time.
Filing a claim
Group MedicareBlue Rx may cover prescriptions filled at out-of-network pharmacies in certain situations. If you use an out-of-network pharmacy, you will generally have to pay the full cost of the drug at the time you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim using the form below. If you need to be reimbursed for a compound drug or vaccine, please submit the Medicare Part D prescription claims form along with the corresponding compound or vaccine claim form below for faster processing.
Financial assistance for prescription drugs
Medicare beneficiaries who have limited resources and income may be able to get Extra Help, a government financial assistance program that helps pay for Medicare Part D costs.
The Social Security Administration has an online application you can complete to find out if you qualify for the Extra Help program. You can also call the Social Security Administration or Medicare to find out if you qualify.
Group MedicareBlue Rx offers a nationwide network of pharmacies where you can get your prescriptions filled. If your medications focus on treating a chronic condition that involves high-cost or complex drugs, you may need to use a CVS Specialty pharmacy. Group MedicareBlue Rx is supported by CVS Caremark1.
- Find a pharmacy
- Order a printed copy of the pharmacy directory (you will need your member ID number)
- Learn about the CVS Specialty pharmacy
The drug list shows you which drugs are covered by the plan. Group MedicareBlue Rx and a team of health care professionals create the list by selecting drugs that provide the best value and effectiveness.
- Download Group MedicareBlue Rx drug lists
- Contact customer service to order a printed copy of the drug list
- Look up the list of covered insulin and over-the-counter products
- Learn how to request a coverage determination
- Group MedicareBlue Rx offers both four- and five-tier plans; contact your benefit administrator if you aren’t sure how many tiers your plan has
We generally cover drugs on the drug list if the drug is medically necessary, the prescription is filled at a network pharmacy and other plan rules are followed.
Mail order prescription service
You may be able to get your prescriptions delivered by mail. CVS Caremark1 Mail Order Pharmacy2 is the only in-network pharmacy that offers mail order to Group MedicareBlue Rx members. To get the most out of your benefits, use CVS Caremark for your mail order prescriptions.
Use these resources to get started with the mail order service.
- Call CVS Caremark Customer Care with questions 1-866-412-5393 (TTY: 711) 24 hours a day, 7 days a week
- Register or login for the CVS Caremark member portal
- Download the mail order prescription form and mail the completed form to the address listed on the form
Learn more about the mail order service in chapter 3 of your Evidence of Coverage.
Automatic refill and renewal programs
With automatic refills for prescriptions received by mail, we start processing your next refill automatically when our records show you should be close to running out of your prescription. With automatic renewal, CVS Caremark contacts your doctor to renew prescriptions before they expire.
If you sign up for the automatic refill program, the pharmacy will contact you before shipping each refill to make sure you still need the prescription filled. You can cancel the scheduled refill if you don't need it. If you no longer want to use the automatic refill program, contact CVS Caremark Customer Care.
Learn more about the automatic refill and renewal programs in chapter 3 of your Evidence of Coverage.
1CVS Caremark Part D Services is an independent company providing pharmacy benefit management services.
2Not all prescription drugs are eligible for this service and not all pharmacies offer this service. Contact Group MedicareBlue Rx customer service if you have questions or need assistance determining if you may use this service.
Transition supply of prescription drugs
In certain situations, you may be able to get a temporary (transition) one-month supply of your prescription drug, even if it's not covered on our drug list or has restrictions (e.g., prior authorization, quantity limit, step therapy). A transition supply gives you time to work with your doctor to find a drug alternative, get a prior authorization or request a formulary exception.
You may be eligible for a transition supply if you are:
- A new group member during the first 90 days in our plan
- A group member who is in a long-term care facility beyond the first 90 days of membership in our plan
- A group member who is negatively affected by a formulary (drug list) change from one year to the next
Learn about our transition supply policy in your Evidence of Coverage, or read the full transition policy. If you have questions or want to find out if you're eligible for a transition supply, contact customer service.