Monday, February 08, 2010

---

	A multi-tier formulary is available for members with a prescription drug card that includes copayments. Tier 1 will cost the member the least out-of-pocket expenses. Please note that the formulary is subject to change at any time during the year without prior notification to members or providers. This is due to the continual efforts we make to evaluate new drugs coming to market, generic drugs becoming available, as well as new FDA rulings on diseases drugs can treat.

Upcoming Changes to the Medicare Blue PPO Formulary     Frequently Asked Questions     How to request a coverage determination and an appeal     Coverage Determination and Appeals Summary If you have questions, please contact our pharmacy help desk. Our knowledgeable staff is available to answer questions from members or providers regarding our formulary and pharmacy benefits. You can reach the pharmacy help desk at 1-877-293-8628, 8 a.m. until 6 p.m., Monday through Friday.

Provided by Blue Cross and Blue Shield of Oklahoma refer to HCSC Insurance Services Company, which is a wholly owned subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company. These companies are independent licensees of the Blue Cross and Blue Shield Association and offer or provide services for Medicare Advantage under contract H3709 with the Centers for Medicare and Medicaid Services. ®Service Mark of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

Serviced and Administered by

H3709_Web-OKWebsiteg CMS Approval Date: 11/2008