Prescription Drugs​ | Excellus BlueCross BlueShield (2024)

Formularies and drug search

Your prescription drug benefit is based on a list of covered drugs called aformulary. A group of independent doctors and pharmacists chooses the drugs for our formularies based on their effectiveness, safety and value. If you want to save the most on your drug costs, ask your doctor if a generic or preferred brand-name drug is right for you.

Different formularies may cover different drugs, place drugs at different copayment tiers or have different management programs. Speak with your human resources department or refer to your benefit document if you’re not sure which of the following applies to you.

Lowest Net Cost (LNC) Formulary

Drug Search2023|2024

Drug Tiers

Each drug in the formulary is assigned atierunder your benefit plan. Each tier is associated with a copayment or coinsurance amount. This is the amount you pay when you get a prescription. Refer to your benefit document to find the amounts that apply to you.

Common tier groupings include:

  • Generic— For the lowest out-of-pocket expense, you should always consider generic drugs if you and your doctor decide they are right for you.
  • Preferred Brand— Consider preferred brand-name drugs if no generic drug is available to treat your condition.
  • Nonpreferred Brand— These are usually the highest-cost products. When a generic becomes available, most of the time the brand-name version will move to nonpreferred status.
  • Specialty— Most plans have one or more tiers designated for specialty drugs.

Nonformulary and excluded drugs

From time to time, our pharmacy committee may decide to no longer cover some drugs. The committee does this when other safe, effective, less costly alternatives are available. Those drugs are then moved to nonformulary status. Additionally, some plans may exclude coverage for certain categories of drugs, such as those for weight loss, fertility or sexual dysfunction. You and your doctor always have the freedom to choose the medication that works best for you. Find more information here.

Drug management programs

Not all members have all of these programs. Also, different formularies may include different drugs within these programs. Please check your Schedule of Benefits to find out which ones apply to you.

  • Prior Authorization — Most of our members need prior authorization for certain drugs.
  • Quantity Management — This program limits the amount of certain drugs your plan will cover.
  • Step Therapy — This program requires members to try one or more Step 1 drugs before their plans will cover Step 2 drugs.Speak with your human resources department or refer to your benefit document if you’re not sure which of the following applies to you.

Speciality drugs

Specialty drugs are prescription medications that are used to treat complex or chronic medical conditions like cancer, rheumatoid arthritis, multiple sclerosis and hepatitis, just to name a few. Depending on your plan, you may pay a different copayment or coinsurance for specialty drugs under the pharmacy benefit.

Some members are subject to separate management programs for specialty drugs that are covered under their medical benefit. For those members, some medical (injectable or infusible) specialty drugs require prior authorization. In addition, some infused specialty drugs must be administered at a specific site of care, such as at home or at an infusion suite. Certain self-administered specialty drugs are only covered under the pharmacy benefit.

Maintenance drugs

Maintenance drugs are prescription drugs you take on a long-term basis. They may be used to treat a chronic condition or may be products taken routinely, such as birth control pills. Prescriptions for these products often can be filled for 90 days at a time. Some health plans require 90-day fills for maintenance drugs.Check your member guide for details.

Mail service

Somehealth plans include a mail service benefit. Home delivery by mail is an easy and convenient way to save time and trips to the pharmacy. If you are eligible for this service, please call the home delivery pharmacy at 855-811-2218. A representative will explain the steps you will need to take to set up mail service. Check your benefit documents to see if your health plan offers mail service.

Preventive drugs

These are drugs that may help prevent serious illnesses and complications. Taking preventive drugs, as directed by your doctor, may help you live a healthier life today and avoid serious illness in the future. Under health care reform, the Affordable Care Act requires most health plans to cover certain drugs at $0 cost to members. Additionally, IRS guidelines for high-deductible health plans provide that preventive care, including prescription medications used for preventive purposes, can be excluded from the deductible. Talk to your benefits coordinator to learn if your plan offers this benefit.

Generic drugs

Generic drugs become available when patents expire on brand-name drugs. They contain the same active ingredients as brand-name drugs but are not manufactured under a brand name or trademark. The color and shape of the generic drug may be different from its brand-name counterpart, but the active ingredients are the same for both. Generic drugs must meet the same U.S. Food and Drug Administration quality standards as the brand-name drugs.

Some members have a Dispense as Written generic program as part of their prescription drug benefit. This means if a member has a prescription for a particular brand-name drug that is also available in generic form, he or she will pay more for that brand-name drug if he or she opts to fill it instead of the generic version. If your doctor feels that the generic version is not appropriate for you, he or she can request an exception detailing why the member must have the brand-name drug over the generic version.

No-cost blood glucose meter

Monitoring your blood sugar is an important part of managing diabetes. That’s why we encourage our members to use OneTouch® products. OneTouch products are preferred on ourformulary which means switching to OneTouch can save you money.

Talk to your doctor about whether OneTouch is a good option for you. If your doctor agrees to the switch, you can get a new OneTouch meter at no cost to you. Several options are available.

To get your free OneTouch meter, just print this voucher and take it, along with your member ID card, to a network pharmacy. Your doctor will need to write you a prescription for your new OneTouch test strips. All other test strips are nonpreferred and require prior authorization.

Medication adherence

The treatment of chronic illnesses often requires the long-term use of prescription drugs. While these long-term, or maintenance, medications are effective in combating disease, many patients don’t get their full benefits because they don’t take their medications as prescribed. Proper use of prescription drugs is called medication adherence. If your plan includes the medication adherence program, you may get letters or phone calls if we note that you haven’t been keeping up with taking your medication. Medical conditions that are monitored within the program include diabetes, hypertension, high cholesterol and other chronic conditions.

Opioid management

To help fight the ongoing national opioid crisis, we have put a program in place based on U.S. Centers for Disease Control and Prevention guidelines. It consists of daily quantity limits specific to each covered opioid drug. It also includes prior authorization requirements for certain prescribing situations. It limits the amount of opioid medication we will cover for first-time prescriptions.

Prescription Drugs​ | Excellus BlueCross BlueShield (2024)


What is a list of prescription drugs covered by an insurance plan? ›

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

What pharmacies take Blue Cross Blue Shield Illinois? ›

Preferred network pharmacies include Jewel-Osco, Mariano's, Walgreens, Walmart and other independent pharmacies.

What pharmacies take Blue Cross Blue Shield of Texas? ›

You may choose either type, but you will usually save money by paying a lower copay or coinsurance when you use a preferred pharmacy. Preferred network pharmacies include Albertsons, Brookshire's, H-E-B, Kroger, Randalls, Tom Thumb, United Supermarkets, Walgreens, Walmart, and other independent pharmacies.

What pharmacies accept Blue Cross Blue Shield of Alabama? ›

Blue Cross and Blue Shield of Alabama in-network specialty pharmacies are: Accredo Health Group, Inc. (1-888-608-9010), CVS/Caremark (1-800-237-2767) and AllianceRx Walgreens Prime (1-877-627-6337).

What is the list of drugs approved by an insurance company? ›

Your health insurance plan includes a list called a formulary -- a directory of the drugs it covers. If you've ever been stunned at how much it cost you to fill a prescription, it's possible that medication wasn't on your formulary. The formulary is also called a preferred drug list (PDL).

How to get Ozempic approved by insurance for weight loss? ›

This is called prior authorization, and it means your doctor will need to submit a form to your insurance company showing that Ozempic is "medically necessary" for your health. Your insurance company will let you know if the request has been approved or denied.

Does Blue Cross Blue Shield of Illinois cover prescription drugs? ›

As a Blue Cross Community Health PlansSM member, you have coverage for selected generic prescriptions, brand name prescriptions, over-the-counter (OTC) drugs, and selected medical supplies.

Does Blue Cross & Blue Shield of Illinois cover weight loss drugs? ›

Blue Cross and Blue Shield of Illinois told NPR that benefits offered by employer plans can vary. "Weight-loss drugs like Wegovy may be covered, depending on the member's benefit plan," a spokesperson for the company said.

Is Walgreens in network with BCBS il? ›

AllianceRx Walgreens Pharmacy, a central specialty and home delivery pharmacy, is contracted to provide mail pharmacy services to members of Blue Cross and Blue Shield of Illinois.

Does CVS take BCBS Texas? ›

Therefore, BCBSTX has made the decision to no longer include CVS pharmacies within the pharmacy network. Members will continue to have access to more than 55,000 nationwide pharmacies in network (without CVS), with more than 4,000 located within Texas.

Does Walmart accept Blue Cross Blue Shield of Texas? ›

Following payments can be made with cash at MoneyGram® locations near you (including most Walmart, ACE Cash Express and CVS stores).

Does Blue Cross Blue Shield Texas use express scripts? ›

Express Scripts® Pharmacy is a trademark of Express Scripts Strategic Development, Inc. Prime Therapeutics LLC is a pharmacy benefit management company, contracted by BCBSTX to provide pharmacy benefit management and related other services.

Does CVS take BCBS Alabama? ›

"CVS Pharmacy continues to accept all commercial plans offered by BCBS Alabama, which are typically through large employers and other groups of over 50 participants," said Gary Serby, Director of Corporate Communications for CVS. "CVS Pharmacy also continues to accept all BCBS Alabama Medicare Part D plans."

Who is the pharmacy benefit manager for Blue Cross Blue Shield of Alabama? ›

Prime Therapeutics serves as Blue Cross' Pharmacy Benefit Manager.

Does Blue Cross Blue Shield Alabama work in other states? ›

Most Blue Cross Blue Shield members can rest easy since Blue Cross Blue Shield coverage opens doors in all 50 states and is accepted by over 90 percent of doctors and specialists. And if your extended travel plans take you abroad, you can ensure you have access to quality care through GeoBlue.

What is a drug plan's list of covered drugs called? ›

A plan's list of covered drugs is called a “formulary,” and each plan has its own formulary. Medicare drug coverage typically places drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost.

What is a list of drugs that are covered under an insurance plan called quizlet? ›

A list of drugs that are covered under an insurance plan is called the. formulary.

What is the best prescription drug plan for seniors? ›

Summary: Compare the Best Medicare Part D Plans for 2024
ProductForbes Health Ratingslearn_more_cta_below_text
UnitedHealthcare5.0On Chapter's Website
Cigna4.8On Chapter's Website
Humana4.6On Chapter's Website
Aetna4.4On Chapter's Website
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May 8, 2024

Can I buy a stand-alone prescription drug plan? ›

stand-alone prescription drug coverage

It's possible, however, to obtain stand-alone drug plans in the non-Medicare market, although they're usually prescription discount plans rather than insurance (here's an explanation of how that works).


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