FEP Medicare Prescription Drug Program (MPDP)

The FEP Medicare Prescription Drug Program, or MPDP, is a prescription drug benefit exclusively for Blue Cross and Blue Shield Federal Employee Program (FEP) members with Medicare. It’s part of your Blue Cross and Blue Shield Service Benefit Plan coverage, which means there’s no separate premium for your prescription drug coverage.

With MPDP, you will have additional approved prescription drugs in some tiers, get lower out-of-pocket costs for higher-cost drugs and have a cap on the amount you pay out-of-pocket on prescriptions annually. You will continue to receive the same FEP health plan benefits you’re used to—these will not change.

Each member on your contract enrolled in MPDP will receive their own member ID card. This new card will include your member ID number, which you should use for all of your medical care. It will include your new MPDP ID number, which the pharmacy needs to fill your prescriptions and submit claims to CVS Caremark. MPDP member ID cards will be mailed in late November or early December of 2023.

With MPDP, you have a larger pharmacy network than the traditional FEP pharmacy benefit. You will have access to over 65,000 in-network (Preferred) retail pharmacies. You can use our Pharmacy Locator tool to find a participating in-network pharmacy.

Yes, you can re-enroll in the traditional FEP prescription drug benefit at any time after the MPDP effective date of January 1, 2024. To disenroll from MPDP, download and complete the MPDP disenrollment form and mail it to: FEP Medicare Prescription Drug Program, PO Box 3539, Scranton, PA 18505. Once Medicare processes your disenrollment request, we will re-enroll you in the traditional FEP prescription drug benefit.

With MPDP, you will no longer be required to fill specialty drugs through the current Speciality Pharmacy Program. You may fill your prescriptions at participating in-network retail pharmacies in our network.

If you do not have an existing prior authorization or coverage determination, your doctor can request one effective December 1, 2023, for the new plan year effective January 1, 2024, as the member cannot submit a Prior Authorization request.

You can use our Pharmacy Locator tool to find a participating in-network pharmacy.

No, the FEP Medicare Prescription Drug Program (MPDP) is only available to residents of the U.S. or a U.S. territory. You cannot purchase drugs overseas under this benefit. Guam is considered overseas; however, some pharmacies may be able to bill electronically.

If you take a maintenance medication and you intend to go overseas for an extended period of time, you may be eligible for an extended filling of the prescription before you leave the U.S. This will require a 12-month prescription from your doctor and is not applicable for controlled substances. Contact our Pharmacy Program at 1-888-338-7737 to learn more.

We assign each covered drug to a tier. There are four tiers for MPDP:

• Tier 1: Generic drugs
• Tier 2: Preferred brand name
• Tier 3: Non-preferred brand name
• Tier 4: Specialty drugs

You can use our Prescription Drug Cost tool to see which tier your medication is in. If you’re a member and logged in to MyBlue, you can access a personalized drug cost tool that shows you the cost of prescription drugs for your specific plan.

You can view the approved drug lists (formularies) for each plan with MPDP:  FEP Blue Focus, FEP Blue Basic and FEP Blue Standard. 

Cost estimates can be found on fepblue.org/medicarerx. You can also use our Prescription Drug Cost Tool to check drug costs. If you’re a member and logged in to MyBlue, you can access a personalized drug cost tool that shows you the cost of prescription drugs for your specific plan.

Yes, the prescription drug benefit for FEP Blue Focus, FEP Blue Basic and FEP Blue Standard are considered “creditable coverage” under Medicare Part D.

Extra Help is a Medicare program that helps pay your Medicare drug costs. Visit ssa.gov/medicare/part-d-extra-help to find out if you qualify and apply. You can also visit Medicare.gov/ExtraHelp to learn more.

We will process a retroactive election if all the following conditions are met:

• The Part D enrollee believes that any delay in filling the prescription(s) due to the 24 hours time frame required to process their request to opt in may seriously jeopardize their life, health, or ability to regain maximum function; and

• The Part D enrollee requests retroactive election within 72 hours of the date and time the urgent claim(s) were adjudicated.

You can contact Customer Care at 1-888-338-7737 (TTY: 711) for more information.

Please contact Customer Care at 1-888-338-7737 (TTY: 711). Available 24 hours a day, 365 days a year.

Yes. We are working to transfer members’ prescription history, including claims information and any active prior authorization to a new FEP MPDP account. This will allow you to continue receiving any current mail order prescriptions with minimal disruptions.  

However, the following prescriptions cannot be transferred: 

• Prescriptions that are expired, or have no refills
• C-2 Controlled Substance Rx
• C-3, C-4, C-5 prescription that has not yet been filled at the current pharmacy 
• Compounded Prescriptions

The Mail Service Pharmacy is a convenient and cost-effective way for you to order up to a 90-day supply of maintenance or long-term medication. You can have your long-term medication delivered to your home or doctor’s office of your choice with free standard shipping. By using mail service, you minimize trips to the pharmacy while saving money on your prescriptions.

For prescription refills with no issues (e.g., not expired or out of refills), you can expect your order to be shipped from our pharmacy within two (2) business days after the order is placed. Orders are shipped on the first business day once processing has been completed. You should expect to receive your prescription within five (5) to seven (7) days after it has been shipped. 

For any new prescriptions, we will need to contact your prescriber. You can expect your order to be shipped from our pharmacy within five (5) business days once it is received, provided your prescriber responds to our request. Orders are shipped on the first business day once processing has been completed. You should expect to receive your new prescription within seven (7) to ten (10) days after it has been shipped. 

While we are transferring active and refillable mail order prescriptions to the new MPDP account, we will not mail members’ refills automatically. Members must call Customer Care at 1-888-338-7737 or go to caremark.com (registration required), on or after January 1, 2024, to provide billing information, including payment preferences.

Medications from our Mail Service Pharmacy are shipped from the closest mail service location to the member's address on file. Medications are shipped in accordance with manufacturer’s requirements for safe transportation.

You can choose one of these methods: 

• Call 1-888-338-7737 and let the Mail Service Pharmacy contact your doctor and arrange for your first mail-order supply. We can assist you with most medications. 

• Ask your doctor for a new prescription for up to a 90-day supply, plus refills for up to one (1) year (if appropriate). Then, ask your doctor to e-prescribe or fax the prescription to the Mail Service Pharmacy. (Only your doctor can fax your prescriptions; the fax number is 1-800-378-0323.

You can check your refill order status on MyBlue or by calling 1-888-338-7737 toll-free. 

The Mail Service Pharmacy offers automatic refills, a home delivery service enhancement designed to assist you in never running out of your medication. After enrolling your maintenance prescriptions in the program, we will automatically calculate your prescription usage and day’s supply remaining. When it’s time to refill your prescription, we will fill it automatically and mail it to your home. Through your preferred method of communications, you will receive a notification seven (7) days before your next refill starts processing. You can change the next processing date or cancel the prescription from the automated refills service any time before processing begins.

Your copay for a 90-day supply depends on several factors, including whether the medication is a brand or generic product. To find out your copay, use our Prescription Drug Cost Tool. You can call 1-888-338-7737 toll-free to confirm your copay amount. If you’re a member and logged in to MyBlue, you can also access a personalized drug cost tool that shows you the cost of prescription drugs for your specific plan. 

Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). This notice gives you a summary of your prescription drug claims and costs. This is not a bill but a tool to provide you with a monthly snapshot of your prescription benefit utilization. 

Chart 1 will provide your medications covered under your Medicare Part D benefit. 

Chart 1A will also be included in your EOB if any of your Enhanced MPDP coverage is utilized.

Chart 2 will show your yearly prescription drug spend for Medicare Part D drugs only and will not include the drugs covered under the Enhanced MPDP coverage.

Chart 3 will indicate the four benefit stages in a Medicare Part D benefit. FEP has provided you an enhanced benefit where there are only two benefit payment stages as an MPDP member – the initial coverage and catastrophic stages. 

For FEP Blue Standard with MPDP:
When you’ve paid $2,000 out-of-pocket for your prescription drugs for the calendar year, you’ve reached your out-of-pocket maximum. This means we will cover any remaining prescription drug costs you have through the end of the year. This is also known as the Catastrophic Coverage Stage.

For FEP Blue Basic with MPDP: 
When you’ve paid $3,250 out-of-pocket for your prescription drugs for the calendar year, you’ve reached your out-of-pocket maximum. This means we will cover any remaining prescription drug costs you have through the end of the year. This is also known as the Catastrophic Coverage Stage.

For FEP Blue Focus with MPDP: 
When you’ve paid $3,250 out-of-pocket for your prescription drugs for the calendar year, you’ve reached your out-of-pocket maximum. This means we will cover any remaining prescription drug costs you have through the end of the year. This is also known as the Catastrophic Coverage Stage.

You will get an Explanation of Benefits monthly. 

The FEP Medicare Prescription Drug Program (MPDP) sends the EOB.

Review your notice and check it for mistakes.

Contact the FEP Medicare Prescription Drug Program (MPDP) number on your member ID card, 24 hours a day, 365 days a year if you have questions, find mistakes, or suspect fraud.