Formulary home

Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx share a Medicare prescription drug list. This list is based on a preferred list of FDA-approved prescription drugs and was developed using guidelines from the federal government. The drug list includes more than 2,500 drugs, including generic, brand name and specialty drugs. Many of the most popular prescriptions are included. Certain vaccinations, insulin and insulin injection supplies are also covered. Over-the-counter drugs are not covered because they are excluded by Medicare.

Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name 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.

To determine if your drugs are covered by Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx, click the button below to search the drug list.

Drug search

Tips for using the drug list

  • Prior authorization and quantity limitations - To encourage the appropriate use of prescription drugs, some quantities are limited and some drugs must be approved before they will be covered.
  • Drug list changes - The drug list may change from time to time. These changes may include the removal of a drug from the formulary or a change in the payment level.
  • 60-day notice - If you are affected by a change to the formulary, you will receive written notice regarding the change.
  • If you can't find your drug - Your drug may not be covered, if you do not find it on the drug list. To verify whether a drug is covered, you may call Customer Service toll-free 7 days a week from 8:00 a.m. to 8:00 p.m.

    Blue Medicare Rx 1-888-247-4142; TTY/TDD 1-888-247-4145
    Blue Medicare HMO 1-888-310-4110; TTY/TDD 1-888-451-9957
    Blue Medicare PPO 1-877-494-7647; TTY/TDD 1-888-451-9957
  • If your drug is not covered - If Blue Medicare HMO, Blue Medicare PPO or Blue Medicare Rx does not cover your drug, you have the right as a member to request that an exception be made to the formulary or to request a transition supply, while you find an appropriate alternative prescription.

    For instructions on how to request a transition supply or an exception to the formulary, and instructions on how to appeal a decision about an exception or to file a grievance if you are dissatisfied for any reason, please review the following documents:

Limitations and exclusions - Like most insurance coverage, our Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx plans have some limitations and exclusions.



Blue Medicare HMO and Blue Medicare PPO plans are offered by PARTNERS National Health Plans of North Carolina, Inc. (PARTNERS), a subsidiary of Blue Cross and Blue Shield of North Carolina (BCBSNC). PARTNERS is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. Plans are administered by BCBSNC. BCBSNC and PARTNERS do not discriminate based on color, gender, religion, national origin, age, race, disability, handicap, sexual orientation, genetic information, source of payment or health status as defined by the Centers for Medicare & Medicaid Services (CMS). All qualified Medicare beneficiaries may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or another third party. BCBSNC and PARTNERS are independent licensees of the Blue Cross and Blue Shield Association.

The information on this page is current as of 11/04/08.

H3404_xxxx, xx/xx/xx, H3449_xxxx, xx/xx/xx, S5540_xxxx, xx/xx/xx

Pending CMS Approval