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■ Or visit our website at www.floridablue.com/medicare <br />Important Information <br />Our plans group each medication into a tier. The number of tiers may vary based on the plan you <br />choose. You will need to use your formulary to locate what tier your drug is on to determine how <br />much it will cost you. The amount you pay depends on the drug's tier and what stage of the benefit <br />you have reached. Through this document you will see the "0" symbol. Services with this symbol may <br />require prior authorization from the plan before you receive the services from network providers. If <br />you do not get a prior authorization when required, you may have to pay out -of -network cost-sharing, <br />even though you received services from a network provider. Please contact your doctor or refer to the <br />Evidence of Coverage (EOC) for more information about services that require a prior authorization <br />from the plan. <br />329 <br />