The Record

Additional drugs covered under Medicare Part B now available at retail pharmacies

Beginning in April, pharmacies can begin billing Medicare Plus Blue℠ plans directly for certain drugs approved for coverage under the Medicare Part B benefit. Previously, many retail pharmacies were unable to bill Part B medications directly and often charged members in full for these drugs. This required members to complete and submit a reimbursement form to Blue Cross Blue Shield of Michigan.

Any existing cost share for these drugs still applies, according to the member’s plan.

The table below lists the medication types and how they will be processed.

Drug type

What’s new

Medicare Advantage Plan(s) included

Nebulizer solutions

Will automatically process under Part B if member lives at home and under Part D if member resides in a long-term care or skilled nursing facility

Medicare Plus Blue℠ plans with or without prescription coverage if Blue Cross ID card used**

Select oral cancer medications

Will process under Part B; no prior authorization required

Medicare Plus Blue℠ plans with or without prescription coverage if Blue Cross ID card used

Oral antiemetics and immunosuppressants

Will process under the appropriate benefit once a coverage review of Part B versus Part D is complete

Medicare Plus Blue℠ plans with prescription coverage***

**For members without a Medicare Plus Blue prescription drug plan who reside in a long‑term care or skilled nursing facility, bill using their Part D plan ID card.

***For members without a Medicare Plus Blue prescription drug plan, if the oral antiemetic or immunosuppressant is approved for Part B coverage, bill using the CMS 1500 form.

View the lists of Medicare Part B drugs available at point of service depending on the member’s plan as follows:
Medicare Plus Blue only
Medicare Plus Blue with prescription drug coverage

Exclusions
Prescription Blue℠ PDP members are excluded from this program.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2020 American Medical Association. All rights reserved.