[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-209934-en":3,"doc-seo-209934-105":30,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":4,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29},209934,1099525198933,"Terk","https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d",7,"Healthcare","Blue Retiree Rx - 2025 Formulary - Drug List","Blue Retiree Rx 2025 Formulary provides the plan’s Drug List (formulary) of covered prescription therapies selected as part of a quality treatment program. The document explains how coverage depends on medical necessity, network pharmacy dispensing, and adherence to plan rules. It outlines how and when the formulary can change, including updates posted monthly, tier or restriction changes, immediate substitutions for certain drug versions, drugs removed from the market, and notice timing for other changes.","Blue RetireeSM Rx  \n2025 Formulary  \n(List of Covered Drugs or “Drug List”)  \nPLEASE READ: THIS DOCUMENT CONTAINS INFORMATION  \nABOUT THE DRUGS WE COVER IN THIS PLAN  \nHPMS Approved Formulary File Submission ID 00025385, Version 18  \nThis formulary was updated on 10/01/2025 . For more recent information or other questions, please contact Blue Retiree Rx at 1-888-645-6025, or, for TTY users 711, [8 a.m. to 8 p.m](8 a.m. to 8 p.m)., Eastern Time, Monday through Friday. Our automated telephone system handles calls received after 8 p.m. and on Saturdays, Sundays, and holidays. From October 1 to March 31, we are available 8 a.m. to 8 p.m. Eastern Time, seven days a week. [Or visit](Or visit www.SCBluesMedAdvantage.com)[ ](Or visit www.SCBluesMedAdvantage.com)[www.SCBluesMedAdvantage.com](Or visit www.SCBluesMedAdvantage.com).  \nNote to existing members: This Formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take.  \nWhen this Drug List (Formulary) refers to “we,” “us”, or “our,” it means BlueCross BlueShield of South Carolina. When it refers to “plan” or “our plan,” it means Blue Retiree Rx.  \nThis document includes a Drug List (formulary) for our plan which is current as of 10/01/2025 . For an updated Drug List (formulary), please contact us. Our contact information, along with the date we last updated the Drug List (formulary), appears on the front and back cover pages.  \nYou must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January 1, 2026, and from time to time during the year.  \nWhat is the Blue Retiree Rx formulary?  \nIn this document, we use the terms Drug List and formulary to mean the same thing. A formulary is a list of covered drugs selected by Blue Retiree Rx in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part ofa quality treatment program. Blue Retiree Rx will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Blue Retiree Rx network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.  \nFor a complete listing ofall prescription drugs covered by Blue Retiree Rx, please visit our website or callus. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages.  \nCan the formulary change?  \nMost changes in drug coverage happen on January 1, but Blue Retiree Rx may add or remove drugs on the formulary during the year, move them to different cost-sharing tiers, or add new restrictions. We must follow the Medicare rules in making these changes. Updates to the formulary are posted monthly to our website [here:](here: www.SCBluesMedAdvantage.com)[ ](here: www.SCBluesMedAdvantage.com)[www.SCBluesMedAdvantage.com](here: www.SCBluesMedAdvantage.com).  \nChanges that can affect you this year: In the below cases, you will be affected by coverage changes during the year:  \n• Immediate substitutions of certain new versions of brand name drugs and original biological products. We may immediately remove a drug from our formulary ifwe are replacing it with a certain new version of that drug that will appear on the same or lower cost-sharing tier and with the same or fewer restrictions. When we add a new version of a drug to our formulary, we may decide to keep the brand name drug or original biological product on our formulary, but immediately move it to a different cost-sharing tier or add new restrictions.  \nWe can make these immediate changes only if we are adding a new generic version of a brand name drug or adding certain new biosimilar versions of an original biological product, that was already on the formulary (for example, adding an interchangeable biosimilar tha","cbCaigjVatE4bBdi","https://ap.wps.com/l/cbCaigjVatE4bBdi","pdf",2413106,1,86,"English","en",105,"# Blue Retiree Rx 2025 Formulary\n## What the formulary means and when drugs are covered\n## Can the formulary change?\n## Changes that can affect members this year\n## Immediate substitutions\n## Drugs removed from the market\n## Other changes and member notice","[{\"question\":\"What is the Blue Retiree Rx formulary and what does it cover?\",\"answer\":\"The formulary is the plan’s Drug List of covered drugs selected in consultation with health care providers. Blue Retiree Rx generally covers drugs on the list when they are medically necessary, filled at a Blue Retiree Rx network pharmacy, and all plan rules are followed.\"},{\"question\":\"How and when can the formulary change in 2025?\",\"answer\":\"Most changes in drug coverage happen on January 1, but drugs may be added, removed, moved to different cost-sharing tiers, or given new restrictions during the year. Updates are posted monthly on the plan website.\"},{\"question\":\"What kinds of changes may affect members during the year?\",\"answer\":\"Members may experience immediate substitutions of certain new versions (including specific biosimilar situations), removal of drugs withdrawn for safety or effectiveness reasons, and other changes such as added prior authorization, quantity limits, or step therapy restrictions. Notice is required at least 30 days before many changes become effective, with some exceptions tied to refill timing.\"}]","Blue Retiree Rx - 2025 Formulary - Drug List | PDF",1788637096,217,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":28},"blue-retiree-rx-2025-formulary-drug-list","",{"@graph":36,"@context":85},[37,54,68],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/document/","Document",2,{"item":49,"name":12,"@type":43,"position":50},"https://docshare.wps.com/document/healthcare/",3,{"item":52,"name":13,"@type":43,"position":53},"https://docshare.wps.com/document/blue-retiree-rx-2025-formulary-drug-list/209934/",4,{"url":52,"name":13,"@type":55,"author":56,"headline":13,"publisher":58,"fileFormat":61,"inLanguage":23,"description":14,"dateModified":62,"datePublished":62,"encodingFormat":61,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":41,"name":59,"@type":60},"DocShare","Organization","application/pdf","2026-09-05",true,{"@type":65,"interactionType":66,"userInteractionCount":4},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"What is the Blue Retiree Rx formulary and what does it cover?","Question",{"text":75,"@type":76},"The formulary is the plan’s Drug List of covered drugs selected in consultation with health care providers. Blue Retiree Rx generally covers drugs on the list when they are medically necessary, filled at a Blue Retiree Rx network pharmacy, and all plan rules are followed.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"How and when can the formulary change in 2025?",{"text":80,"@type":76},"Most changes in drug coverage happen on January 1, but drugs may be added, removed, moved to different cost-sharing tiers, or given new restrictions during the year. Updates are posted monthly on the plan website.",{"name":82,"@type":73,"acceptedAnswer":83},"What kinds of changes may affect members during the year?",{"text":84,"@type":76},"Members may experience immediate substitutions of certain new versions (including specific biosimilar situations), removal of drugs withdrawn for safety or effectiveness reasons, and other changes such as added prior authorization, quantity limits, or step therapy restrictions. Notice is required at least 30 days before many changes become effective, with some exceptions tied to refill timing.","https://schema.org",{"og:url":52,"og:type":87,"og:title":13,"og:site_name":59,"og:description":14},"article",{"robots":89,"canonical":52},"index,follow",{"doc_id":7,"site_id":24},{"code":4,"msg":5,"data":92},[93,97,101,105,110,115,118,123,128,131,135],{"id":20,"doc_module":4,"doc_module_name":46,"category_name":94,"show_sort_weight":95,"slug":96},"Story & Novel",90,"story-novel",{"id":47,"doc_module":4,"doc_module_name":46,"category_name":98,"show_sort_weight":99,"slug":100},"Literature",80,"literature",{"id":53,"doc_module":4,"doc_module_name":46,"category_name":102,"show_sort_weight":103,"slug":104},"Exam",70,"exam",{"id":106,"doc_module":4,"doc_module_name":46,"category_name":107,"show_sort_weight":108,"slug":109},5,"Comic",60,"comic",{"id":111,"doc_module":4,"doc_module_name":46,"category_name":112,"show_sort_weight":113,"slug":114},6,"Technology",50,"technology",{"id":11,"doc_module":4,"doc_module_name":46,"category_name":12,"show_sort_weight":116,"slug":117},40,"healthcare",{"id":119,"doc_module":4,"doc_module_name":46,"category_name":120,"show_sort_weight":121,"slug":122},8,"Research & Report",30,"research-report",{"id":124,"doc_module":4,"doc_module_name":46,"category_name":125,"show_sort_weight":126,"slug":127},9,"Religion & Spirituality",20,"religion-spirituality",{"id":126,"doc_module":4,"doc_module_name":46,"category_name":129,"show_sort_weight":126,"slug":130},"World Cup","world-cup",{"id":132,"doc_module":4,"doc_module_name":46,"category_name":133,"show_sort_weight":132,"slug":134},10,"Lifestyle","lifestyle",{"id":136,"doc_module":4,"doc_module_name":46,"category_name":137,"show_sort_weight":106,"slug":138},19,"General","general"]