Responsible Rx Program updates on medication guides and coverage requirements and limitations (January, April, July, and October)
Changes to Florida Blue’s individual and employer group pharmacy programs occur each quarter of the calendar year. These changes affect drug coverage from the medication guides, including prior authorization requirements, the Responsible Quantity and Responsible Step programs, and the Pharmacy Coverage Exclusions list. Florida Blue makes this information available to our in-network providers and viewable for our Florida Blue members.
Medication guides for Medicare eligibles
The medication guides are updated monthly. Links are included below to the Medicare approved formularies and the most recent updates to the printed version of the medication guide for Medicare eligibles.
Please have your patient refer to the pharmacy endorsement or rider issued with his or her contract, Evidence of Coverage, member handbook or certificate of coverage to determine whether a particular medication listed is covered. If your patient is unsure about particular coverage/benefits or has questions about the medication guide, please have the member call the customer service number on his or her ID card. The fact that a particular drug is listed in the guide does not necessarily mean that it is covered under each member's contract, Evidence of Coverage or certificate of coverage.
1If you are not sure if your plan is a small, large, or self-funded group, please ask your benefit administrator.