Part 5 – Covered Services (continued) IMPORTANT: Refer to the Schedule of Benefits for your plan option for the cost share amounts that you must pay for covered services and for the benefit limits that may apply to specific covered services. Once you reach your benefit limit for a specific covered service, no more benefits are provided by Blue Cross Blue Shield HMO Blue for those services or supplies. WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 56 covered drug or supply. Or, you can also go online and log on to the Blue Cross Blue Shield HMO Blue Web site at www.bluecrossma.org. Mail Order Pharmacy Benefits There are certain covered drugs and supplies that you may not be able to buy from the Blue Cross Blue Shield HMO Blue designated mail order pharmacy. To find out if your covered drug or supply qualifies for the mail order pharmacy benefit, you can check with the mail order pharmacy. Or, you can call the Blue Cross Blue Shield HMO Blue customer service office. Mail Order with Retail Choice Program Some plan options include the Mail Order with Retail Choice Program. The Schedule of Benefits for your plan option will tell you when you have this program. (Also refer to riders—if there are any—that apply to your coverage in this health plan.) If your health plan includes this program, the Mail Order with Retail Choice Program applies for certain covered maintenance drugs. These drugs are shown on the Blue Cross Blue Shield HMO Blue drug list. When you buy any one of these maintenance drugs from a covered retail pharmacy, this health plan covers only two fills of the same drug within a 365-day period. In order to receive coverage for more fills of the same drug from a covered retail pharmacy, you will be asked to choose whether you want to continue to receive your drug fills from the retail pharmacy or whether you will receive your drug fills from the covered mail order pharmacy. After you buy your first fill of the listed drug from the retail pharmacy, you will receive a letter from Blue Cross Blue Shield HMO Blue that will tell you how to make your choice. If you do not make a choice before you buy a third fill, the covered mail order pharmacy will automatically qualify as your choice. No retail pharmacy coverage will be provided for more than two fills of the same drug unless you have chosen the retail pharmacy option. To find out which maintenance drugs are on the drug list, you can call the Blue Cross Blue Shield HMO Blue customer service office. The toll free phone number to call is shown on your ID card. Or, you can also go online and log on to the Blue Cross Blue Shield HMO Blue Web site at www.bluecrossma.org. This list of drugs may change from time to time. For example, this list of drugs may change as new drugs become available. Please check for updates when a drug is prescribed for you for the first time. Or, Blue Cross Blue Shield HMO Blue may change the classes of drugs that are on this drug list. In this case, Blue Cross Blue Shield HMO Blue will send you a notice. Covered Drugs and Supplies This drug coverage is provided for:  Drugs that require a prescription by law and are furnished in accordance with Blue Cross Blue Shield HMO Blue medical technology assessment criteria. These covered drugs include, but are not limited to: birth control drugs; oral diabetes medication that influences blood sugar levels; hormone replacement therapy drugs for peri- and post-menopausal members; certain drugs used on an off-label basis (such as: drugs used to treat cancer; and drugs used to treat HIV/AIDS); abuse-deterrent opioid drug products on a basis not less favorable than non-abuse deterrent opioid drug products; oral antibiotics for the treatment of Lyme disease; and drugs for HIV associated lipodystrophy syndrome.  Injectable insulin and disposable syringes and needles needed for its administration, whether or not a prescription is required. (When a copayment applies to your pharmacy coverage, if insulin, syringes,