Blue MedicareRx (PDP)
Plan Support

We encourage you to let us know right away if you have questions or problems related to your prescription drug coverage. Federal law guarantees your right to make complaints if you have concerns with any part of your care. You cannot be disenrolled from your plan or penalized in any way if you make a complaint.

A complaint will be handled as a coverage determination, appeal, or grievance, depending on the subject of the complaint.

Coverage Determination

Before purchasing a prescription drug, you have the right to get a written explanation (called a coverage determination) about your benefits. A coverage determination explains:

  • whether a certain drug is covered
  • whether you meet our requirements to get a drug
  • how much you will pay for a drug
  • whether we can make an exception to a coverage rule

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You can submit an appeal if you disagree with a coverage or payment decision made by us or by Medicare. An appeal requests us to reconsider our decision and make a redetermination about a case. If you disagree with our redetermination, additional appeals are available to you.

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Fraud, Waste, and Abuse

Health care fraud increases costs for everyone. We are committed to fighting healthcare fraud, waste, and abuse. You can help by learning how to identify and report possible cases.

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A grievance is a formal complaint you can file with us regarding plan or pharmacy service issues. If you are unhappy with the way you were treated or experience unsatisfactory service, you have the right to file a grievance.

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Out-of-Network Coverage

Generally, you must use pharmacies in the Blue MedicareRx (PDP) network to receive coverage benefits. However, we may cover out-of-network purchases under certain circumstances.

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