Quality Assurance
The Evidence of Coverage (EOC) includes information on our quality assurance policies and procedures. You can find information regarding drug management programs such as utilization management (prior authorizations, quantity limits, step therapy and generic substitutions) and medication therapy management. Within the EOC, quality assurance policies can be found beginning on page 17 in section 2.

Medication Therapy Management
The RxBLUE (PDP) Medication Therapy Management program is available at no cost for members who meet specific criteria. Members who have multiple medical conditions, who are taking certain prescription drugs or who have high drug costs may be eligible for the program. More information can be found on page 18 of the EOC or by contacting Customer Service. 

Contract Termination and Member Rights
RxBLUE (PDP) has a contract with the Centers for Medicare & Medicaid Services (CMS) that may be renewed each year. However, either RxBLUE (PDP) or CMS can decide to end the contract at any time. If we leave the Medicare program or no longer offer prescription drug coverage in the service area where you live, we will notify you in writing. If either situation occurs, your membership in our Plan will end, and you will have to enroll in another Medicare Prescription Drug Plan or in a Medicare Advantage Plan with prescription drug coverage to continue receiving prescription drug benefits. More information can be found in the Evidence of Coverage (EOC) beginning on page 42.

Our Organization contracts with the Federal government. RxBLUE (PDP) is a stand-alone prescription drug plan with a Medicare contract.

Benefits, formulary, pharmacy network, premium and co-payments/co-insurance may change on January 1, 2010. Please contact RxBLUE (PDP) for details.

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Pending CMS Approval