Check Drug Lists | Excellus BlueCross BlueShield (2024)

What is a Formulary?

A formulary (also known as a drug list) is a list of brand-name and generic drugs (or medications) that are covered under your prescription drug benefit. If you have a question about coverage, pricing, or rules, contact Customer Care using the number on the back of your member card.

Formularies

Medicare / Dual Special Needs Plans (D-SNP)

Visit our Medicare member’s Check Drug Lists to view your plan’s formulary.

Small Group / Individuals and Families / College Plans

Applies to small groups (plans offered by employers with 100 employees or less), individuals and families who purchase their health plan on their own from NY State of Health (including the Essential Plan) or directly from Excellus BCBS, and college plans.

  • 2023 3-Tier Formulary - 2981Open a PDF
  • 2024 3-Tier Formulary - 2981Open a PDF

Upcoming Changes

  • 2023 3-Tier Formulary - 2981Open a PDF
  • 2024 3-Tier Formulary - 2981Open a PDF

Midsize / Large Group

Applies to midsize and large groups (plans offered by employers with more than 100 employees)

  • 3-Tier Formulary - 2950Open a PDF
  • 2023 3-Tier State Mandate Formulary - 2950Open a PDF
  • 2024 3-Tier State Mandate Formulary - 2950Open a PDF
  • Preferred Value Formulary - 3295Open a PDF
  • Preferred Value State Mandate Formulary - 5578Open a PDF
  • National Preferred Formulary - 3624Open a PDF

Upcoming Changes

  • 3-Tier Formulary - 2950Open a PDF
  • 2023 3-Tier State Mandate Formulary - 2950Open a PDF
  • 2024 3-Tier State Mandate Formulary - 2950Open a PDF
  • Preferred Value Formulary - 3295Open a PDF
  • Preferred Value State Mandate Formulary - 5578Open a PDF

Medicaid Managed Care / HARP

Applies to those with Blue Choice Option, HMOBlue Option, or Blue Option Plus

Beginning April 1, 2023, all Medicaid members enrolled in Blue Choice Option, HMO Blue Option, and Blue Option Plus will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.

Learn more about the transition of the pharmacy benefit from Blue Choice Option, HMO Blue Option, and Blue Option Plus to NYRx, the Medicaid Pharmacy Program.

Access general information about NYRx, the Medicaid Pharmacy Program, along with additional information for Members and Providers.

Child Health Plus

Applies to those with Child Health Plus through Excellus BCBS.

  • Formulary – 2977Open a PDF

Upcoming Changes

  • Child Health Plus Formulary - 2977Open a PDF

Other Offerings and Programs

  • Medication Assurance Program and Drug ListOpen a PDF
  • Patient Assurance Program and Drug ListOpen a PDF
  • Contraceptive List for plans without Prescription Drug coverageOpen a PDF
  • Preventive Drug List for select HDHP plansOpen a PDF
  • Preventive Drug List - National Preferred Formulary for select HDHP plansOpen a PDF

Specialty Drug List

Applies to commercial groups (plans offered by employers), individuals and families who purchase their health plan on their own from NY State of Health (including the Essential Plan) or directly from Excellus BCBS, and Child Health Plus through Excellus BCBS.

The following specialty drugs must be purchased from one of our participating specialty pharmacies in order to receive coverage under your prescription drug benefit (for medications that are self-administered).

  • Specialty Drug List (Self-Administered Drugs)Open a PDF
  • Bassett Specialty Drug ListOpen a PDF
  • National Preferred Formulary - Specialty Drug ListOpen a PDF

Mandatory Maintenance Medication List

Some benefit plans require certain medications to be purchased through Express Scripts, Wegmans Home Delivery, or a mail order home delivery pharmacy.

  • Medications Requiring Mail Order or Home Delivery ServiceOpen a PDF
  • National Preferred Formulary - Medications Requiring Mail Order or Home Delivery ServiceOpen a PDF

Specific Employer Groups

  • Bassett Healthcare Network - Medications Requiring Mail Order or Home Delivery ServiceOpen a PDF
  • Rochester Regional Health System - Medications Requiring Mail Order or Home Delivery ServiceOpen a PDF

Prior Authorization and Step Therapy Lists

Group Plans (Small, Midsize, and Large)

Applies to groups (plans offered by employers)

  • 3-Tier Prior Authorization and Step Therapy ListOpen a PDF
  • 2023 3-Tier State Mandate Formulary Prior Authorization and Step Therapy ListOpen a PDF
  • 2024 3-Tier State Mandate Formulary Prior Authorization and Step Therapy ListOpen a PDF
  • National Preferred Formulary Prior Authorization and Step Therapy ListOpen a PDF

Child Health Plus

Applies to those with Child Health Plus through Excellus BCBS

  • Child Health Plus Prior Authorization and Step Therapy ListOpen a PDF

Exception Review Requests

Some drugs require an exception review before they will be covered. To request an exception review for a drug that requires prior authorization, step therapy, or has a quantity limit, you may:

  • Speak with your doctor, who may submit a request on your behalf
  • Contact Customer Care at 1-800-499-1275 (TTY 711) or by fax at 1-800-956-2397
  • Submit a Prescription Drug Coverage Request via secure eForm
Check Drug Lists | Excellus BlueCross BlueShield (2024)

FAQs

How do I get a list of my medications? ›

How do I make a medication list?
  1. Handwriting a simple list on a piece of paper.
  2. Using a medication reminder app on a smartphone where you enter in the medications you take.
  3. Obtaining a medication list document from a healthcare provider's office.
  4. Downloading a blank medication list form online and filling it out.
Jan 19, 2022

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 do I know what tier my drug is? ›

Level or Tier 1: Low-cost generic and brand-name drugs. Level or Tier 2: Higher-cost generic and brand-name drugs. Level or Tier 3: High-cost, mostly brand-name drugs that may have generic or brand-name alternatives in Levels 1 or 2. Level or Tier 4: Highest-cost, mostly brand-name drugs.

What is a list of drugs approved for coverage known as? ›

A drug list, also called a formulary, is a list of prescription drugs covered by your health plan.

Is there an app to list my medications? ›

Protect yourself and your family by using the free MyRxProfile app to keep track of your prescription and over-the-counter medications and identify potential ADRs before they occur.

Is there a medication database? ›

Consumer information about specific drugs (including prescription uses, side effects, special precautions, etc.) is available from the American Society of Health-System Pharmacists' searchable drug database.

How to get Ozempic covered by insurance? ›

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.

What are three drugs that require prior authorization? ›

Drugs That May Require Prior Authorization
Drug ClassDrugs in Class
ArikayceArikayce
Attention Deficit Hyperactivity Disorder Non-Stimulant MedicationsAtomoxetine, Clonidine ER, Guanfacine ER, Intuniv, Kapvay, Strattera
AuryxiaAuryxia
AustedoAustedo
241 more rows

What if I need a prescription but can't afford it? ›

Drug Assistance Program. Many pharmaceutical companies, state programs and nonprofits have drug assistance programs (PAPs) that offer free or low-cost medicines if you don't have insurance or are underinsured and can't afford your medicine.

What tier is Xanax? ›

Fortunately, many insurance plans classify alprazolam as a Tier 1 drug with the lowest possible copay cost. Alprazolam belongs to a class of drugs called benzodiazepines. Benzodiazepines are controlled substances and may cause abuse and dependence (and if stopped abruptly, withdrawal symptoms).

What tier is Adderall? ›

Medicare prescription drug plans typically list amphetamine salt combo XR (adderall XR) on Tier 4 of their formulary. Generally, the higher the tier, the more you have to pay for the medication. Most plans have 5 tiers.

What are tier 1, 2, 3, 4, 5 drugs? ›

What does each drug tier mean?
  • Tier 1: Preferred generic drugs. These are commonly prescribed generic drugs. ...
  • Tier 2: Generic drugs. These are also generic drugs, but they cost a little more than Tier 1 drugs. ...
  • Tier 3: Preferred brand drugs. ...
  • Tier 4: Nonpreferred drugs. ...
  • Tier 5: Specialty drugs.
Feb 6, 2024

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

Health plans usually have a list of drugs they have already approved for coverage. This list is called a formulary. Health plans often place drugs into different drug tiers on the formulary.

What drugs are Class A list? ›

Class A drugs include:
  • cocaine.
  • crack cocaine.
  • ecstasy ( MDMA )
  • heroin.
  • LSD.
  • magic mushrooms.
  • methadone.
  • methamphetamine (crystal meth)

How do insurance companies decide which drugs to cover? ›

In practice, insurers use an internal committee or group, often called a pharmacy and therapeutics committee, to review formulary changes. According to the Insurance Department, these committees typically meet quarterly to review new drugs and, if the drugs are to be covered, determine the drugs' formulary tiers.

How do I keep track of my medications? ›

Keeping Track of Medicines
  1. Make a master list of all your medicines. Write down the medicine names and doctors' names. ...
  2. Plan a daily schedule of medicines. ...
  3. Keep your pills in a pillbox. ...
  4. Set reminders. ...
  5. Make it routine. ...
  6. Don't run out. ...
  7. Learn more about how to take medicines safely.

How do I find my medication list on my iPhone? ›

View medication history
  1. On your iPhone or iPad, open the Health app.
  2. If you're on your iPhone, tap Browse. If you're on your iPad, tap sidebar. to open the sidebar.
  3. Tap Medications.
  4. Scroll to Your Medications, then tap a medication.

What is the app for medication information? ›

Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products.

Where can I get information relating to medication? ›

Your pharmacist should always be your first port of call if you have any questions about medicines.

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