FEP Medicare Prescription Drug Program (MPDP)
New for 2024: A Medicare prescription drug benefit for eligible members who qualify for Medicare Part A and/or Medicare Part B utilizing Medicare as their Primary Health Care coverage.
Introducing the FEP Medicare Prescription Drug Program
The FEP Medicare Prescription Drug Program (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—there’s no separate premium for your prescription drug coverage.
Questions, call 1-888-338-7737 (TTY: 711).
If it's after-hours, you can leave us a voicemail and we will return your call the next business day.
Download GuideA closer look at MPDP
Same FEP Benefits
Continue to receive the same FEP health plan benefits you’re used to.
Additional Approved Drugs
Have additional approved prescription drugs in some tiers than your current benefit.
Lower Costs
Get lower out-of-pocket costs for higher cost drugs.
Out-of-Pocket Maximum
Have a cap on the amount you pay out-of-pocket on prescriptions annually.
Eligibility
You are eligible for MPDP if you are:
- An FEP member
- Enrolled in Medicare Part A and/or Part B primary
- A resident of the U.S. or a U.S. territory
Drug Tiers
MPDP has four drug tiers:
- Tier 1: Generics
- Tier 2: Preferred brand name
- Tier 3: Non-preferred brand name
- Tier 4: Specialty drugs
How to get your prescriptions
You can order prescriptions and refills at one of our 65,000+ in-network retail pharmacies or through the FEP Mail Service Pharmacy (Basic and Standard Option only).
Specialty drugs are considered tier 4 drugs with MPDP. Depending on how the drug is dispensed, you can buy specialty drugs by going to a retail pharmacy or by mail.
MPDP benefits by plan compared to your benefits with Medicare
| FEP Blue Focus Traditional Pharmacy Benefit with Medicare Part B | FEP Blue Focus with MPDP Pharmacy Benefits | |
|---|---|---|
|
In-network Retail Pharmacy^ |
Tier 1: $5 copay Tier 2: 40% of our allowance ($350 max) |
Tier 1: $5 copay Tier 2: 40% of our allowance ($350 max) Tier 3: 40% of our allowance ($350 max) Tier 4: 40% of our allowance ($350 max) |
|
FEP Mail Service Pharmacy** |
Not a benefit | Not a benefit |
| FEP Specialty Pharmacy† | Tier 2: 40% of our allowance ($350 max) | Your specialty drug benefits are in Tier 4 (see above) |
|
Annual Pharmacy Out-of-Pocket Maximum* |
Not a benefit | $3,250 per member |
MPDP benefits by plan compared to your benefits with Medicare
| Basic Option Traditional Pharmacy Benefit with Medicare Part B | Basic Option with MPDP Pharmacy Benefits | |
|---|---|---|
|
In-network Retail Pharmacy^ |
Tier 1: $10 copay Tier 2: $50 copay Tier 3: 50% of our allowance ($60 min) Tier 4: $80 copay Tier 5: $100 copay |
Tier 1: $10 copay Tier 2: $45 copay Tier 3: 50% of our allowance ($60 min) Tier 4: $75 copay |
|
FEP Mail Service Pharmacy** |
Tier 1: $20 copay Tier 2: $100 copay Tier 3: $125 copay |
Tier 1: $15 copay Tier 2: $95 copay Tier 3: $125 copay Tier 4: $150 copay |
| FEP Specialty Pharmacy† |
Tier 4: $80 copay Tier 5: $100 copay |
Your specialty drug benefits are in Tier 4 (see above) |
|
Annual Pharmacy Out-of-Pocket Maximum* |
Not a benefit | $3,250 per member |
MPDP benefits by plan compared to your benefits with Medicare
| Standard Option Traditional Pharmacy Benefit with Medicare Part B | Standard Option with MPDP Pharmacy Benefits | |
|---|---|---|
|
In-network Retail Pharmacy^ |
Tier 1: $5 copay Tier 2: 30% of our allowance Tier 3: 50% of our allowance Tier 4: 30% of our allowance Tier 5: 30% of our allowance |
Tier 1: $5 copay Tier 2: 15% of our allowance Tier 3: 50% of our allowance Tier 4: $60 copay |
|
FEP Mail Service Pharmacy** |
Tier 1: $10 copay Tier 2: $90 copay Tier 3: $125 copay |
Tier 1: $5 copay Tier 2: $85 copay Tier 3: $125 copay Tier 4: $150 copay |
| FEP Specialty Pharmacy† |
Tier 4: $65 copay Tier 5: $85 copay |
Your specialty drug benefits are in Tier 4 (see above) |
|
Annual Pharmacy Out-of-Pocket Maximum* |
Not a benefit | $2,000 per member |
^ What you'll pay for a 30-day supply of covered drugs. You can see what you'll pay for a 31- to 90-day supply of covered drugs in the benefits brochure.
** What you'll pay for up to a 90-day supply of covered drugs.
† What you'll pay for up to a 30-day supply of covered drugs.
* You still have an overall medical out-of-pocket maximum. Your MPDP pharmacy out-of-pocket maximum is part of it, not added to it.
What is an out-of-pocket maximum?
A unique benefit of MPDP is that you have an annual pharmacy out-of-pocket maximum. An out-of-pocket maximum is a cap (or maximum) on the amount you’ll pay in copays and coinsurance. In the case of MPDP, it’s a cap on the amount you’ll pay on prescription drugs for the year. Once you reach the maximum for the year, you pay nothing for your prescriptions for the rest of the year.
You still have an overall medical out-of-pocket maximum. Your MPDP pharmacy out-of-pocket maximum is part of it, not added to it.
Auto Enrollment Process
FEP will automatically enroll eligible members in MPDP.
Starting October 2023 FEP will automatically enroll eligible members (for an effective date of January 1, 2024) who:
- Have Medicare Part A and Part B primary
- Are not enrolled in a Medicare Advantage (MA) plan
- Do not have Medicare because of End-Stage Renal Disease (ESRD)
- A resident of the U.S. or a U.S. territory
If you meet the above criteria, you will receive an eligibility letter in the mail after October 2023.
If you want to keep your current FEP prescription drug benefits, you need to let us know.
Once you receive the eligibility letter, you’ll have 26 days to let us know you want to opt out before we send your new member ID card. You can opt out by calling 1-888-338-7737 or by mail to FEP Medicare Prescription Drug Program, PO Box 3539, Scranton, PA 18505.
Information on your rights and responsibilities is available in your evidence of coverage.
What you need to know
If you are not part of the automatic enrollment and want MPDP, you can still get it
You can elect to enroll any time on or after November 13, 2023, the first day of Open Season. Download an enrollment form to get started:
If you miss the opt-out deadline in the letter
You can tell us at any point that you want the regular FEP prescription drug benefits instead of MPDP.
If it’s before January 1, 2024, you can call us at 1-888-338-7737 (TTY: 711).
Before or after January 1, you can also contact Medicare at 1-800-MEDICARE (1-800-633-4227) or mail us at: FEP Medicare Prescription Drug Program, PO Box 3539, Scranton, PA 18505.
If you decide to opt out or dis-enroll, you can re-enroll during Open Season in a future year.
Medication Therapy Management (MTM) Program
If you have complex prescription drug needs, this program is available to you to get support from a pharmacist. They’ll help ensure you get the most out of your current drug therapy.
Learn More about MTM
MPDP 2024 Summary of Benefits
2024 Summary of Benefits - FEP Blue Focus
2024 Summary of Benefits - Basic Option
2024 Summary of Benefits - Standard Option
The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.
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