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 55 HMO Blue in order for you to receive this drug coverage. A covered pharmacy will tell you if your drug needs prior approval from Blue Cross Blue Shield HMO Blue. They will also tell you how to request this approval.  The drug or supply is prescribed for your use while you are an outpatient.  The drug or supply is purchased from a pharmacy that is approved by Blue Cross Blue Shield HMO Blue for payment for the specific covered drug and/or supply. This means that for most covered drugs and supplies, you may buy your drug or supply from any covered retail pharmacy. However, for some specialty drugs and supplies, you may need to buy your drug or supply from covered pharmacies that specialize in treating specific diseases and that have been approved by Blue Cross Blue Shield HMO Blue for payment for that specific specialty drug or supply. For a list of these specialty drugs and supplies and where to buy them, you can call the Blue Cross Blue Shield HMO Blue customer service office. Or, you can look on the internet Web site at www.bluecrossma.org. The Drug Formulary The Blue Cross Blue Shield HMO Blue Drug Formulary is a list of Blue Cross Blue Shield HMO Blue approved drugs and supplies. Blue Cross Blue Shield HMO Blue may update its Drug Formulary from time to time. In this case, your coverage for certain drugs and supplies may change. For example, a drug may be added to or excluded from the Drug Formulary; or a drug may change from one member cost share level to another member cost share level. For the list of drugs that are excluded from the Blue Cross Blue Shield HMO Blue Drug Formulary, you can refer to your Pharmacy Program booklet. This booklet was sent to you as a part of your evidence of coverage packet. Please check for updates. You can check for updates or obtain more information about the Blue Cross Blue Shield HMO Blue Drug Formulary, including the most current list of those drugs which are not included on the formulary, by calling the Blue Cross Blue Shield HMO Blue customer service office. The toll free phone number to call is shown on your ID card. You can also go online and log on to the Blue Cross Blue Shield HMO Blue Web site at www.bluecrossma.org. The Drug Formulary Exception Process Your drug coverage includes a Drug Formulary Exception Process. This process allows your prescribing health care provider to ask for an exception from Blue Cross Blue Shield HMO Blue. This exception is to ask for coverage for a drug that is not on the Blue Cross Blue Shield HMO Blue Drug Formulary. Blue Cross Blue Shield HMO Blue will consider a Drug Formulary exception request if there is a medical basis for your not being able to take, for your condition, any of the covered drugs or an over-the-counter drug. If the Drug Formulary exception request is approved by Blue Cross Blue Shield HMO Blue, you will receive coverage for the drug that is not on the Blue Cross Blue Shield HMO Blue Drug Formulary. For this drug, you will pay the member cost share amount that you would pay if this drug were a non-preferred prescription drug. Buying Covered Drugs and Supplies For help to obtain your drug coverage, 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. A Blue Cross Blue Shield HMO Blue customer service representative can help you find a pharmacy where you may buy a specific drug or supply. They can also help you find out which member cost share level you will pay for a specific