Formulary (list of covered drugs)

Blue Advantage (HMO) and Blue Advantage (PPO) members are automatically enrolled in Medicare Part D drug coverage. A formulary is a list of covered drugs selected by Blue Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.

Blue Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Blue Advantage network pharmacy, and other plan rules are followed.
Find and Price Prescription Drugs

Special Note Regarding Generic Drugs

A generic drug has the same active ingredient as the brand-name version of the drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs. If your brand-name drug is not listed in our formulary, it may be listed in its generic form. Check with your doctor or pharmacy to see if a generic is available.

Download a Print Version

If you would like to download a print version our 2020 Prescription Drug Formulary you can do so by clicking the link below.

Our drug formulary may change during the year. These changes will be updated regularly. You can view any changes that have been made to the 2020 prescription drug formulary by clicking the link below.

Restrictions on Coverage

Some covered drugs may have requirements or limits on coverage. You can find out if your drug has any of these by looking in the formulary. These requirements and limits may include:

Prior Authorization

We require you to get prior authorization for certain drugs. This means that your doctor will need to get approval from the plan before you fill your prescription. If they don’t get approval, we may not cover the drug. Click on the link below to view the prior authorization criteria used by the plan to determine if the drug is covered.
Learn more about Prior Authorization Criteria

Step Therapy

We may require that you try one or more alternative drugs for your health condition before we will cover the drug you are requesting. If you have already tried other drugs or your doctor thinks other drugs are not right for your situation, you or your doctor can ask the plan to cover the requested drug. Click on the link below to view the step therapy criteria used by the plan.
Learn more about Step Therapy Criteria

Quantity Limits

For certain drugs, Blue Advantage limits the amount of the drug that the plan will cover per prescription or for a defined period of time. For example, Blue Advantage provides 18 tablets per 28 day prescription for sumatriptan.

Generic Substitution

In most cases, when there is a generic version of a brand-name drug available, our network pharmacies will give you the generic version. We usually will not cover the brand name drug when a generic version is available. However, if your provider has told us the medical reason that neither the generic drug nor other covered drugs that treat the same condition will work for you, then we will cover the brand name drug. (Your share of the cost may be greater for the brand name drug than for the generic drug.)

If your drug is subject to one of these additional restrictions or limits, and your physician determines that you are not able to meet the additional restriction or limit for medical necessity reasons, you or your physician can request an exception (which is a type of coverage determination).

Y0132_19-529_ITLU - Last updated 01/30/2020