13549
This health plan includes the Maintenance Choice Exclusive pharmacy program for certain covered maintenance drugs. When the member purchases a 90-day supply of these covered drugs from a retail pharmacy included in this program, the cost share amount is the same amount that would apply if these drugs were purchased through the covered mail service pharmacy after retail deductible is met (if any). If any of these covered drugs are purchased from a covered retail pharmacy that is not included in this program or if less than a 90-day supply is purchased from a retail pharmacy that is included in this program, benefits are provided for up to two fills of the same drug within a 180-day period. For additional retail fills of the same drug within this period, the member will pay all charges. To find out which drugs are on the Maintenance medication list, the member may call the Blue Cross and Blue Shield customer service office. Refer to rider for more information.