Some drugs require prior authorization before they are covered by your plan. If you fail to get authorization first, you may be responsible for paying the entire cost of the medication. Learn more about requesting a prior authorization or see a list of the drugs that require it.
Some drugs require Step Therapy to guarantee coverage. This means that if both Drug A and Drug B treat the same condition, you may have to try using Drug A before we cover Drug B. See a list of the drugs that require Step Therapy.
The list of drugs covered under your plan may change throughout the year, including either adding or removing some drugs, changing the prior authorization requirement or coverage tier, or others. See our list of drug changes.
We offer a printable list of the drugs covered under your plan (also called a formulary).
You can search our list of drugs covered under your plan (also called a formulary), to make sure your prescription is covered. Our plans generally cover the drugs on our list as long as they are medically necessary, prescriptions are filled at in-network pharmacies and other plan rules are followed.
As a Blue Cross of Idaho member, you have the right to ask us to make an exception to our prescription drug coverage rules. You can ask us to cover a drug that's not on our list of covered drugs, cover a drug at a lower cost-sharing level or even waive coverage restrictions. Learn more here.
You have the right to appeal a decision made about your Part D coverage.
If you enroll in a new plan or there is a drug list update that has a negative effect on you, it's called a Part D Transition.
Depending on the drug, there may be coverage limits or additional requirements for coverage. These guidelines not only help our members use their prescription medications effectively, but they help keep drug costs down.
It's important to not only take your prescription medications correctly, but to make sure you are taking appropriate drugs. To help do this, we do drug utilization reviews for all our members to ensure their prescriptions are safe, effective and not causing negative interactions with each other.
If you are taking numerous drugs at the same time, there is a risk for interaction problems, as well as increasing out-of-pocket costs. Our Medication Therapy Management Program (MTMP) can help you learn more about your medications, reduce the risk of problems and help you and your healthcare providers get the most benefit from your drugs.
Y0010_MK18060 Approved 10/19/2017
Last updated 10/01/2017