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Blue Choice

Prescription Drug Information

Here is where you’ll find all the information you need on our prescription drug coverage.

Drug Lists

  • View the Tiered Prescription Drug List (PDL). With this six-tier PDL, drugs aren’t tied to generic, preferred and non-preferred copayment levels. Some generic drugs and brands with no added value compared to more cost-effective options may be available at higher tiers.
  • Some members with individual coverage remain on the three-tier “legacy” PDL that BlueChoice HealthPlan has used for many years. View the BlueChoice® PDL.
  • The Covered Drug List applies to all remaining BlueChoice Affordable Care Act (ACA) members.
  • Some members need Prior Authorization for certain drugs.
  • The Quantity Management program limits the amount of certain drugs a plan will cover.
  • The Step Therapy program helps ensure quality, cost-effective drug therapy. 
  • The Opioid Management Program consists of daily quantity limits specific to each covered opioid drug and prior authorization requirements for certain prescribing situations.
  • Specialty Drugs — Learn how coverage works.
  • Excluded Drug List — This is a list of drugs that are excluded from coverage. The document also includes information on how to request a formulary exception for an excluded drug.
  • $0 Covered Drug List — Under Health Care Reform, the ACA requires most health plans to cover certain drugs at $0 cost to members.

How Patients Can Save Money

  • Use a Network Pharmacy — For your patients to have coverage under their benefit plan, they should use one of the 66,000+ pharmacies in our network.
  • Lifestyle Medication Discount Program — If your patients have pharmacy benefits through BlueChoice, some non-covered medications may be available to them at a discount.

Helpful Resources

  • Search for a Specific Drug — Use the drug lookup tool to search for a specific drug. (This link leads to a third party website. That company is solely responsible for the contents and privacy policy on its site.) For personal information about their drug coverage, members can log into My Health Toolkit®.
  • Oral Drug Prior Authorization Forms — These are the forms you need for prior authorization.
  • My Health Toolkit — Members can compare drug costs, locate a pharmacy, review their prescription drug histories and much more.