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        • 24-Hour Nurse Line
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        • ER Alternatives
        • Find a Doctor
        • Member Support & Assistance Program
          • In-home Care from Landmark Health
          • In-home Health Assessments with Signify Health®´
          • Personalized Support for Disease Management
          • Quality Optimizer
          • Additional Programs
        • Mental Health
        • Supporting Caregivers
      • Manage Your Health
        • Managing Diabetes
        • Preventive Care
        • Flu Prevention
        • Chronic Care
        • Fall Prevention
        • Urinary Incontinence
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 1-800-678-2265      TTY: 711

8:00 a.m. to 8:00 p.m. ET, Seven Days a Week.

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  • Learn More
    • Intro to Medicare
      • Introduction
      • Eligibility and Enrollment
      • Frequently Asked Questions
      • Your Coverage Choices
      • Original Medicare
      • Medicare Advantage
      • Prescription Drug Coverage
      • Plan that’s Right for you
      • Sign-Up for a Guide Book and Email
      • Medicare Basics Video Series
    • Are You Eligible For Medicare?
    • Are Your Drugs Covered?
    • Attend a Seminar
    • About Medicare
      • Health Plan Basics
      • Important Dates
    • Request a Call
  • Health & Wellness
    • Finding Care
      • 24-Hour Nurse Line
      • Care Management
      • ER Alternatives
      • Find a Doctor
      • Member Support & Assistance Program
        • In-home Care from Landmark Health
        • In-home Health Assessments with Signify Health®´
        • Personalized Support for Disease Management
        • Quality Optimizer
        • Additional Programs
      • Mental Health
      • Supporting Caregivers
    • Manage Your Health
      • Managing Diabetes
      • Preventive Care
      • Flu Prevention
      • Chronic Care
      • Fall Prevention
      • Urinary Incontinence
      • Meals and Nutrition
  • Member Resources
    • Plan Information
      • Plan Documents
      • Quality Assurance
      • National Coverage Determination
      • Ending Membership
    • Pharmacy Benefits
      • Drug Benefits
        • Home Delivery
        • Formulary Overview
        • Coverage Requirements
        • Formulary Changes
      • Medicare Advantage Pharmacy Network
      • Plan Drug Transition Policy
      • Medication Therapy Management
      • Prescription Drug Utilization Review
    • Learn to Live
    • Get More With MyBlue
    • Discounts & Programs
    • Payment Options
    • Fraud & Disaster
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Prescription Drug Utilization Review

To help ensure that the quantity and dosage of your medications remain consistent with manufacturer, clinical, and the Food & Drug Administration (FDA) recommendations, we maintain a list of medications subject to Quantity Limits (QL). When you fill a prescription for a medication subject to QL, your prescription is reviewed for:

  • Dose Consolidation – Dose Consolidation checks to see whether you're taking two or more daily doses of medicine that could be replaced with one daily dose providing the same total amount of medication. Dose Consolidation advantages include:
    • Making it more convenient for you to take your medication (you take fewer pills, instead of several doses or pills daily).
    • Helping control overall pharmacy costs.
  • Recommended Monthly Dosing Level – This process checks to see that your monthly dosage of medication is consistent with both the manufacturer's and the FDA's monthly dosing recommendations and clinical information. Your doctor can also apply for an exception to QL guidelines when medically necessary.

Additional prescription safety and quality measures include:

CVS Caremark®'  – CVS is the prescription mail-order service provider for our Medicare Advantage and Medex®' plans with prescription coverage. When you fill a mail-order prescription, CVS will electronically review it against your previous or current prescriptions. If safety issues are detected, CVS will send an alert to the retail or mail-order pharmacy filling your prescriptions.

Prescription Drug Plans

Blue MedicareRxSM offers two standalone prescription drug plans (PDPs) to residents of Connecticut, Massachusetts, Rhode Island, and Vermont.

Visit the Blue MedicareRx (PDP) website.

Blue Cross Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities that have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.

You can file a complaint if you feel that you received inaccurate, misleading or inappropriate information. Please call Member Service at 1-800-200-4255 (TTY users call: 711). If your complaint involves a broker or agent, be sure to include the name of the broker/agent when filing your complaint.

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