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.
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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
MPDP is a Medicare Part D plan
You may already know that Medicare has 4 parts. Part A and Part B don’t cover prescription drugs. Part D plans offer prescription drug coverage. While FEP prescription drug benefits are considered creditable coverage, meaning they meet Medicare’s minimum requirements, we’re offering MPDP as a Part D plan to help members with Part A and/or Part B save on their prescriptions.
MPDP is just one way we’re making your FEP coverage and Medicare work together for you.
Learn More
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
| FEP Blue Basic Traditional Pharmacy Benefit with Medicare Part B | FEP Blue Basic 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
| FEP Blue Standard Traditional Pharmacy Benefit with Medicare Part B | FEP Blue Standard 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.
Every year in September or October, FEP will automatically enroll eligible members (for an effective date starting the next benefit year) 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 in September or October. If you have previously opted out or disenrolled from MPDP, you will not be automatically enrolled.
You can disenroll if you don’t want MPDP.
You can tell us at any point that you want the regular FEP prescription drug benefits instead of MPDP.
Disenroll by mailing the completed disenrollment form to FEP Medicare Prescription Drug Program, PO Box 3539, Scranton, PA 18505 or by fax to 855-865-1817.
If you decide to disenroll, you can re-enroll during this upcoming or a future year’s Open Season.
Information on your rights and responsibilities is available in your evidence of coverage.
Voluntary Enrollment
If you were not part of the automatic enrollment and want MPDP, you can still get it
You can elect to enroll any time on or after the first day of Open Season. Download an enrollment form to get started:
FEP Blue Focus Enrollment Form
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
The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.
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