What is a Medicare Prescription Drug Plan?

Medicare Prescription Drug Plans provide coverage for prescription drugs and are offered by private insurance companies approved by Medicare, like UTIC Insurance Company.

Back to top

Why should I get Medicare prescription drug coverage?

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.

You can get more information on LEP here.

Back to top

Who is eligible for coverage?

To enroll in BlueRx you must be a resident of Tennessee. You must also be enrolled in 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.

Back to top

What if I have more than one address?

If you have more than one address, you will need to provide your permanent physical address on your application. 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 alterate address (such as a Post Office Box) for billing and/or correspondence.

Back to top

How much does BlueRx cost?

You can view available plans and rates here.

If you qualify for Low Income Subsidy, your premium may be reduced.

Back to top

When can I make changes to my Prescription Drug Plan coverage?

Plan changes may be made during the Annual Election Period, which occurs from October 15 to December 7 of each year. A current Prescription Drug Plan plan enrollee is allowed to make a one-time change during the Medicare Advantage Open Enrollment Period, which takes place from January 1 to March 31 or the last day of the 3rd month after their Part A and B entitlement date. This period allows you to disenroll from a Prescription Drug Plan plan and return to your Original Medicare, change from one Medicare Advantage plan to another Medicare Advantage plan or from one Part D plan to another Part D Plan.

Other times that you are allowed to make changes to your coverage outside of AEP are:

• Initial Coverage Election Period (ICEP) - three months before your 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.

Back to top

How do I enroll in BlueRx?

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.

Back to top

If I enroll in a new plan, when will my prior coverage end?

Your membership will end the last day of the month prior to when your new plan's coverage begins.

Back to top

What are my payment options?

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.

Back to top

What type of discounts will I receive during the coverage gap or donut hole?

Once the amount of drugs you have purchased for the year reaches $5,030 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 $8,000 you will enter the Catastrophic Coverage Phase. During this final phase, you pay nothing for the remainder of the calendar year. 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.

Back to top

What are star ratings?

Medicare developed its Star Rating system to give people with Medicare an objective measure of a health or drug plan’s performance. The rating system gives people a way to consider quality as well as cost as they make their enrollment decisions. Medicare evaluates plans every year and scores them on a scale of 1 to 5 Stars, with 5 Stars indicating the highest performance.

View the BlueRx Star rating.

Back to top

How can I talk with a UTIC Insurance Company representative for more information?

• Call us at 1-888-543-9212 (TTY 711) from 8 a.m. to 8 p.m., 7 days a week.

Back to top

How do I know if my prescription drugs are covered?

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), Monday - Friday, 8 a.m. to 8 p.m. Central Time. From October 1 to March 31, the hours of operation are Monday - Sunday, 8 a.m. to 8 p.m. Central Time. You may be required to leave a message for calls made after hours, weekends and holidays. Calls will be returned the next business day.
• Request that a formulary be mailed to you

Back to top

My drug is not on your formulary. How can I get it added?

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 1-888-311-7508 (TTY 711), Monday - Friday, 8 a.m. to 8 p.m. Central Time. From October 1 to March 31, the hours of operation are Monday - Sunday, 8 a.m. to 8 p.m. Central Time. You may be required to leave a message for calls made after hours, weekends and holidays. Calls will be returned the next business day.

Back to top

Can I fill my prescriptions by mail?

Yes, we offer the convenience of having your medications purchased through our mail order program. 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:

1. Express Scripts Pharmacy
   1. Call 1-833-715-0967 and speak with a trained agent, or
   2. Visit their website: www.express-scripts.com/rx
2. Alliance Rx Walgreens Prime
   1. Call 1-800-731-3588 and speak with a trained agent, or
   2. Visit their website: www.alliancerxwp.com
3. Amazon Pharmacy
   1. Call 1-855-793-5326 and speak with a trained agent, or
   2. Visit their website: pharmacy.amazon.com
4. Kroger PPS
   1. Call 1-800-552-6694 and speak with a trained agent, or
   2. Visit their website: www.ppsrx.com 

Back to top

Do I have drug coverage if I travel outside of Tennessee?

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.

Back to top

What is the difference between a Preferred Cost-Sharing Pharmacy and a Standard Cost-Sharing Pharmacy for beneficiaries in Enhanced or Enhanced Plus?

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.

Back to top

What is the Consumer Assessments of Health Plans (CAHPS) Survey?

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

Back to top

Can I keep my coverage if I move?

This plan is only offered to Alabama and Tennessee Residents. Medicare will allow you 60 days from the day you move to enroll in a Part D plan in your new state.

Please contact our Customer Service to notify us of any changes to your physical address. Failure to report an address change can result in the loss of your coverage.

Back to top

Notices