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