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Rx Savings GuideA helpful handbook for understanding your Medicare Advantage prescription drug plan and saving money

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Your personal drug list:A list of all medications you’re currently taking, including any supplements.

Your personal drug list provides your doctor with a complete overview of what you’re taking. While supplements aren’t covered by your prescription drug plan, they should still be included on this list.

The Blue Care Network drug list:The Blue Care Network formulary (or drug list) is updated for the upcoming plan year every fall. You can see it online at bcbsm.com/formularymedicare.

The Blue Care Network drug list is specifically tailored to your plan. Having a copy on hand allows your doctor to make an informed decision about what drugs are available and any necessary requirements before writing a prescription.

This guide:Your cost-share chart on Page 9 is a helpful resource for your doctor.

This chart can help your doctor make the most cost-effective choice for your medication.

Your retail or mail-order pharmacy contact information:By bringing the name, address and phone number of your chosen pharmacy, you can help ensure that your prescriptions are filled quickly.

Your prescriptions will cost less at a preferred pharmacy. You also have the option of getting a 31-day or 90-day supply of your recurring medication.

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Your doctor can help you save money – here’s howTake these four things with you to your next appointment:

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Take these four things with you to your next appointment:

What’s the best and most cost-effective medication for me?Why is this question important?When your doctor understands what your plan covers, they can best choose safe, effective and less expensive medications.

Many medications effectively treat similar conditions, so your doctor may be able to prescribe medications that cost less.

Ask your doctor one question:

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There’s an easy way for you to savemoney on your prescriptions

Costco PharmacyD & W PharmacyFamily Fare Pharmacy Kmart PharmacyKroger PharmacyMeijer Pharmacy

Rite Aid PharmacySam’s Club PharmacyVG’s PharmacyWalgreens Pharmacy*Walmart Pharmacy

*Walgreens is a preferred pharmacy for retail only.

CVS is a standard pharmacy.

This list is subject to change and doesn’t include preferred chains or independent pharmacies that participate outside of Michigan.

Independent pharmacies may also be preferred. Be sure to check if you use one.

Preferred chainpharmacies in Michigan

Use a preferred retail or mail-order pharmacyPreferred pharmacies have a partnership with Blue Care Network to provide savings to our members. If a pharmacy isn’t preferred, it’s considered standard.

Choosing a preferred pharmacy can save you money on both 31-day and 90-day prescriptions.

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Other pharmacies are available in our network.

• Give us a call at the number on the back ofyour member ID card.

• Visit www.bcbsm.com/pharmaciesmedicare.

• Log in to your member account atwww.bcbsm.com.

Express Scripts (preferred)

Call: 1-877-801-2332TTY users, call 1-800-716-323124 hours a day, seven days a weekwww.express-scripts.com

Call your new preferred pharmacy and let them know you’d like to transfer your prescriptions.

After that, your new preferred pharmacy will handle the transfer.

This option works best for medications you take regularly. Place your order at least two weeks before your medication runs out to make sure you aren’t without it. Mail order isn’t suggested if you need your medications right away.

It’s easy to find a preferred pharmacy:

Transfer your prescriptions with just one call:

Prefer mail order? There are two choices available

AllianceRX Walgreens Prime Home Delivery (standard)

Call: 1-866-877-2392TTY users, call 1-800-573-183324 hours a day, seven days a weekwww.alliancerxwp.com/home-delivery

When searching, preferred pharmacies come up first and are clearly marked as shown below.

PHARMACY A 0.63 mi 123 MAIN ST ANY TOWN, MI–34567-8910 COUNTY: MACOMB 313-555-5555

Preferred pharmacy

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The first step is to see what tier your new or current prescription drug is in.

How? That’s easy. Each drug is listed alphabetically in the Index at the back of the Blue Care Network drug list. Each drug is assigned a Tier, 1 through 6.

You can view it online at bcbsm.com/formularymedicare.

Be sure to select the 2020 BCN Advantage Comprehensive Formulary under the BCN AdvantageSM HMO-POS and HMO plans section.

How much will my drugs cost me this year?

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Understandingyour drug tiers

Drug Tier Description

Preferred GenericThese are generic drugs in the lowest cost-sharing tier.

GenericThese are still generic drugs but not the lowest cost-sharing tier.

Preferred BrandThis tier contains mostly brand-name drugs and also includes some high-cost generics.

Non-Preferred Drug These are brand and generic drugs not in a preferred tier.

Specialty Drugs This contains high-cost generic and brand-name drugs (the highest tier).

Select Care Drugs This is a $0 copay tier at preferred in-network pharmacies.

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Ollie has a new prescription for atenolol. Ollie flips to the Index at the back of the Blue Care Network drug list and finds the page for atenolol. Turning to that page, Ollie sees it’s a Tier 1 drug.

Next, Ollie checks the cost-share chart (on the next page). Ollie sees that under Initial Coverage, a Tier 1 drug atenolol will only cost $1 for a 31-day supply or $3 for a 90-day supply at a preferred retail or preferred mail-order pharmacy. Since the doctor wants Ollie taking atenolol for the next six months, mail order looks like a convenient option for him.

Initial Coverage Coverage Gap (Donut Hole)

Catastrophic Coverage

Cost-share stages

You paid + plan paid = $4,020

You paid = $6,350 Plan year endsMost people don’t go beyond Initial Coverage.

Here’s how it works for your plan, MyChoice Wellness:

For the rest of the year, Ollie’s costs would only change if the total drug spend by Blue Care Network and Ollie exceeded $4,020. Then Ollie would move from Initial Coverage to the Coverage Gap (sometimes called the Donut Hole). Once in the Coverage Gap, for tiers one through six, Ollie would pay 25% of the cost of his drug if it was a generic or a brand-name drug.

However, if Ollie’s total spend for his prescriptions and deductible exceeds $6,350, he would enter Catastrophic Coverage. Then, for all tiers, he would only pay the greater of 5% or $3.60 if it’s a generic, or the greater of 5% or $8.95 if it’s a brand-name drug.

To see how much you and your plan have spent:

• Sign in to your member account at www.bcbsm.com/medicare.

• Give us a call at the number on the back of your member ID card.

• Log in to your member account with the BCBSM mobile app.

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Cost-sharing terms you may hearCopayment (or copay) – A fixed amount that you pay each time you fill a prescription. Your plan pays the remainder of the cost.

Coinsurance – A percentage of the cost of the drug that you pay each time you fill a prescription. Your plan pays the remainder of the cost.

Using preferred pharmacies means lower copays In 2020, if Lulu uses a preferred pharmacy, a Tier 1 drug will only cost her $1.

However, if Lulu uses a standard pharmacy, the same drug will cost $7 for a 31-day supply. So, Lulu would spend $72 more per year than necessary.

Cost-share chart What you’ll pay for a 31-day supply

Drug Tier Initial Coverage Coverage Gap (Donut Hole)

Catastrophic Coverage

Preferred pharmacy $1

Standard pharmacy $7

• Generic 25%

• Brand name 25%

• Genericthe greater of5% or $3.60

• Brand namethe greater of5% or $8.95

Preferred pharmacy $10

Standard pharmacy $18

• Generic 25%

• Brand name 25%

Preferred pharmacy $42

Standard pharmacy $47

• Generic 25%

• Brand name 25%

Preferred pharmacy 48%

Standard pharmacy 48%

• Generic 25%

• Brand name 25%

Preferred pharmacy 33%

Standard pharmacy 33%

• Generic 25%

• Brand name 25%

Preferred pharmacy $0

Standard pharmacy $5

• Generic 25%

• Brand name 25%

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BCN Advantage MyChoice Wellness HMO 2020 Cost Sharing

Here’s how it works for your plan, MyChoice Wellness:

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A 90-day supply is the same price at the pharmacy or by mail order — three times the price of a 31-day supply (90‑day supply isn’t available for Tier 5).

It’s easy to use your prescription drug plan. You can even save money on a 31-day supply by filling your prescription at a preferred pharmacy.

You’ll pay the lowest amount for your prescriptions if you choose a preferred retail or mail-order pharmacy. To ensure you’re paying the lowest cost for your medications, remember to always show your member ID card at the pharmacy.

Did you know?

Why it’s important to follow your doctor’s ordersWhen you take your medications regularly, not only will your doctor be better able to manage your care, doing so will help keep you healthy and may also lower your risk of heart attack, stroke, kidney disease, eye and nerve damage and other illnesses.

Always let your doctor or pharmacist know if you have any trouble or concerns about taking your medications regularly.

Traveling? Plan ahead When you travel, talk to your doctor about a 90-day supply. It’ll help you stay healthy and ensure you’re following your doctor’s treatment plan while you’re away from home.

Suddenly need a prescription? You can find a preferred pharmacy: • At www.bcbsm.com/pharmaciesmedicare• By logging into your member account at

www.bcbsm.com• On the BCBSM mobile app• By calling the Customer Service number on the

back of your member ID card

Your choice: 31-day or 90-day supplyYou have the flexibility to choose a 31-day or 90-day supply of your medication. Choosing a 90-day supply means fewer trips to the pharmacy and less chance you’ll run out of your medications. Additionally, members who receive a 90-day supply of a medication are 20% more likely to take their medication as prescribed compared with members receiving a 31-day supply. You have the option to get a 90-day supply of your medications at a pharmacy or through mail order. Using a preferred retail or mail-order pharmacy will give you the lowest cost.

Understanding your drug supply options

Does my plan cover the newest medications?Blue Care Network always adds treatment options to our Blue Care Network drug lists throughout the year.

We work with a team of pharmacists and physicians to review new medications and update our drug lists accordingly.

We update our drug list during the current year, and annually, as the government approves, restricts or recalls medications. These adjustments are made to keep you safe, introduce new treatment options and keep your costs down.

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Resources for Blue Care Network members

Help paying for your prescription drugsAside from contributing to your long-term health, taking your medications as prescribed by your physician is important for controlling chronic diseases and treating temporary conditions. By taking your medications as directed, hospitalizations, hospital readmissions and disease progression can be slowed or prevented. If you’re struggling to pay for your prescription drugs, the resources below may help you.

Medicare “Extra Help”Medicare provides the Extra Help program to pay prescription drug costs for people with limited income and resources.

If you qualify, you get help paying for any Medicare drug plan’s monthly premium, yearly deductible and prescription copayments. Extra Help also counts toward your out-of-pocket costs.

Medicare 1-800-MEDICARE (633-4227) TTY users, call 1-877-486-2048 24 hours a day, 7 days a week

Social Security 1-800-772-1213 TTY users, call 1-800-325-0778 7 a.m. to 7 p.m. Monday through Friday

Your state Medicaid office 1-855-789-5610 8 a.m. to 7 p.m. Eastern time Monday through Friday

If you need assistance applying for Extra Help, call BCN’s My Advocate program at 1-866-631-5967 (TTY 1-877-644-3244), Monday through Friday, 9 a.m. to 6 p.m.

Blue365 member discount program*This program helps you find health and wellness information and services year-round, including:

• Financial planning

• Weight loss programs

• Travel discounts

• Gym memberships

• Healthy eating

• Personal care

It also provides special member savings and access to content, tools and discount offers available through www.bcbsm.com/discounts.

*This is not a plan benefit. Blue365 offersaccess to health and wellness deals exclusive to Blue members.

Call one of the options below to see if you qualify:

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