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Information for Georgia

Medicare Part D Plans in Georgia

Anthem Blue Cross and Blue Shield of Georgia offers Medicare Part D prescription drug plans (PDPs) to add to your coverage. With copays as low as $0, it’s an important part of your insurance package and it won’t break the bank. And our prescription drug plans complete your Medicare Part D requirement. Whether you get Part D included through a Medicare Advantage Plan or separately added to Medicare Supplement insurance or Original Medicare. We cover over 70,000 pharmacies so you’ll find one close to you. Original Medicare doesn’t cover prescription drugs, so add a drug plan with Blue Cross and Blue Shield of Georgia, and we’ve got you covered.

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Is a Medicare Prescription Drug Plan right for you?


  • You enrolled in Original Medicare, Parts A and B
  • You’re not receiving any prescription drug coverage through an employer or your union
  • You’d like help lowering your prescriptions drug costs
  • You want coverage for prescriptions in the future, even if you don’t take any right now
  • You have a Georgia Medicare Supplement plan or Original Medicare and you need drug coverage to complement your plans


  • You’re already signing up for a Medicare Advantage Plan that includes drug coverage
  • Your union, employer, or a former employer is providing you with drug coverage

Does Blue Cross and Blue Shield of Georgia cover your prescriptions?

Use our prescription search tool to check if we cover your medications.

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When should you buy your Prescription Drug Plan (PDP)?

As soon as you enroll in Original Medicare

The best time to enroll in a Prescription Drug Plan in Georgia is right after you enroll in Original Medicare Parts A and B.  This could be during the three months before your 65th birthday, your birthday month and the three months after, or later when you retire. Each year, you can add or change a PDP during the Annual Election Period (AEP), which lasts from October 15 to December 7. Sometimes you can qualify for a Special Enrollment Period (SEP).

How do you pay for a Medicare Prescription Drug Plan?

The cost of your Medicare Prescription Drug Coverage can depend on the plan you pick and how much money you make. People with higher incomes pay premiums that are a little higher. So depending on your plan, you may have some of the following costs:


The bill that you pay every month for your plan. This bill comes from us, but you can usually arrange to have it taken straight out of Social Security.


An annual amount of money you need to spend before your plan kicks in to pay for you or help you pay.


The percentage or fixed amount that you pay when you get prescriptions filled at the pharmacy.

Coverage Limit

A limit to how much plans can cover in a calendar year. If you reach that limit, you may have to pay for your full medication costs until the end of the year. (Check out exceptions to this limit below.)

Need more help paying for prescription drugs?

You might qualify for more help. A federal program called Extra Help gives you coverage for the premiums, deductibles, copays, and coinsurance expenses of Medicare Part D (drug coverage). To qualify, you must be receiving Original Medicare, living in the United States, and your combined income and assets can’t be worth more than a certain amount ($13,640 as an individual or $27,150 when living with your spouse.) If you qualify for Extra Help, you can enroll in Medicare Part D anytime without having to pay any late enrollment fees.

Learning about Prescription Drug Coverage

Here are some terms you might run into with Medicare Prescription Drug Coverage.

Drug Tiers

All the drugs Anthem covers are divided up into pricing tiers. Basically, generic drugs are the lowest tier and are the most affordable, while brand name medications and specialty drugs are in higher tiers that cost more.

Prior Authorization

In order to cover certain prescription drugs, your plan may require your doctor to clear it with us before writing the prescription and let us know that it’s medically necessary for you.

Step Therapy

For some conditions, there are drugs that do the same thing at different prices. With Step Therapy, you and your doctor can agree to try a less expensive drug first, then “step up” to more expensive drugs if that one isn’t working, or if it becomes medically necessary to do so.

Quantity Limits

For safety reasons, your Prescription Drug Plan may limit the amount of a specific drug you can get. If you refill a prescription too soon, or if you’re prescribed an amount above safety standards, your doctor may need to call us before refilling your prescription in order to keep you covered.

Medicare Part D Plan Exceptions

You and your doctor have the right to ask for exceptions to the limits of your drug plan. You can also apply for an exception from step therapy and quantity limits, or for a lower copayment for a specific drug. Talk to your doctor about getting exceptions when you need them.

The Medication Therapy Management Program

The Medication Therapy Management (MTM) Program is a service for Blue Cross Blue Shield of Georgia members with multiple health conditions to help you understand your medications and use them safely. The program is designed to help you and your doctor make sure that your medicines are working to improve your health. If you qualify, you’ll be auto-enrolled in the program. To qualify for the MTM program, you must be managing 3 or more chronic health problems, take 8 or more daily medicines and spend $3,507 or more per year on Part D covered medications.  If you qualify, you’ll get a comprehensive medication review and can talk to a pharmacist directly.  A summary of that review along with an action plan and personal medication list will be sent to you. You can use these to keep track of your medications and to have available when visiting your doctors.  At least once every 3 months, you’ll get a review of your medications with your doctors involved if needed. MTM services are provided at no additional cost to you and while you may choose not to participate in the program, we recommended that you make use of this free service. 

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Y0114_16_29130_U CMS ACCEPTED 9/29/2016

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are the registered marks of the Blue Cross and Blue Shield Association.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary and pharmacy network may change at any time. You wll recieve notice when necessary. The Anthem Blue Cross and Blue Shield plans are PDP plans with Medicare contracts. Enrollment in Anthem Blue Cross and Blue Shield plans depends on contract renewal.

This information is available for free in other languages. Please call our Customer Service number at 1-800-261-8667, TTY 711, Hours of operation 8 a.m. to 8 p.m. seven days a week (except Thanksgiving and Christmas) from October 1 to February 14, and Monday to Friday (except holidays) from February 15 to September 30. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711). 注意:如果您使用非英語的其他語言,您可以免費獲得語言援助服務。請致電聯絡客戶服務部(聽語障用戶請致電:711)。