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 3,700 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. For Blue Medicare HMO - RAI, click here.

Tips for using the drug list

• Drug tiers - Drugs are assigned into three payment categories, based on usage, cost and clinical effectiveness.
  
  
• 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 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. at 1-888-247-4142 for Blue Medicare Rx; 1-888-310-4110 for Blue Medicare HMO; and 1-877-494-7647 for Blue Medicare PPO. For the hearing and speech impaired, TDD/TTY for Blue Medicare Rx 1-888-247-4145; Blue Medicare HMO 1-888-451-9957; and for Blue Medicare PPO 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:

  • Transition process
  • Coverage determination
  • Appeals process
  • Grievance procedures

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