Generics Plus Formulary - Blue Cross Blue Shield of Illinois

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Coverage considerations Most prescription drug benefit plans provide coverage for up to a 30- to 34-day supply of medication, with some exceptions. Your plan may also provide coverage for up to a 90-day supply of maintenance medications. Maintenance medications are those drugs you may take on an ongoing basis for conditions such as high blood pressure, diabetes or high cholesterol. Some plans may exclude coverage for certain agents or drug categories, like those used for erectile dysfunction (example: Viagra) or infertility (example: Follistim AQ). Over-the-counter exclusions: Some benefit plans do not provide coverage for prescription medications that have an over-the-counter version. You should refer to your benefit plan booklet for details about your particular benefits. Compounded medications: Some benefit plans do not provide coverage for compounded medications. Please see your plan materials or call the number on the back of your ID card to determine whether compounded medications are covered and/or verify your payment amount. Repackaged medications: Repackaged versions of medications already available on the market are not covered. Prior Authorization (PA): Your benefit plan may require prior authorization for certain drugs that are high-cost or have the potential for misuse. This means that your doctor will need to submit a prior authorization request for coverage of these medications, and the request will need to be approved, before the medication will be covered under your plan. For the preferred medications listed in this document, if a prior authorization is commonly required, it will be noted next to the medication with a dot under the prior authorization column as stated in the section “How To Use This List.” Some plans may have prior authorization on additional medications beyond those noted in this document. Step Therapy (ST): Your benefit plan may include a step therapy program. This means you may need to try another proven, cost-effective medication before coverage may be available for the drug included in the program. Many brand drugs have less-expensive generic or brand alternatives that might be an option for you. For the preferred medications listed in this document, if a step therapy is commonly required it will be noted next to the medication with a dot under the step therapy column as noted in the section “How To Use This List.” Some plans may have step therapy programs on additional medications beyond those noted in this document. Dispensing Limits (DL): Drug Dispensing limits help encourage medication use as intended by the FDA. Coverage limits are placed on medications in certain drug categories. For the formulary medications listed in this document, if a dispensing limit applies, it will be noted next to the medication with a dot under the dispensing limits column as explained in the section “How to Use This List.” Limits may include: quantity of covered medication per prescription, quantity of covered medication in a given time period, coverage only for members within a certain age range, and coverage only for members of a specific gender. If your doctor prescribes a greater quantity of medication than what the dispensing limit allows, you can still get the medication. However, you will be responsible for the full cost of the prescription beyond what your coverage allows. For a list of medications and their dispensing limits, visit myprime.com. Remember, medication decisions are between you and your doctor. Only your doctor can determine which medication is right for you. Discuss any questions or concerns you have about medications you are taking or are prescribed with your doctor. Specialty drugs Specialty drugs are used in the treatment of medical conditions such as hepatitis, hemophilia, multiple sclerosis and rheumatoid arthritis. Specialty drugs may be oral or injectable medications that can either be self-administered or administered by a health care professional. For a current list of specialty medications, visit myprime.com. IV Blue Cross and Blue Shield of Illinois April 2013 Drug Formulary
Note that some drug classes may be excluded by some plans and therefore may not be covered under your pharmacy benefit. Your plan may have a different coverage level for specialty drugs. If you have questions about your coverage for specialty medications or your prescription drug benefit, call the number on the back of your ID card. Blue Cross and Blue Shield Generics Plus July 2013 Drug Formulary V
Page 1: Content July 2013 Blue Cross and Bl
Page 4 and 5: II How to use this list This list i
Page 8 and 9: Prime Therapeutics Specialty Pharma
Page 10 and 11: 2013 Drug Name Specialty ribavirin
Page 12 and 13: 2013 Drug Name Specialty ELLA levon
Page 14 and 15: 2013 Drug Name Specialty diltiazem
Page 16 and 17: 2013 Drug Name Specialty PEG - elec
Page 18 and 19: 2013 Drug Name Specialty risperidon
Page 20 and 21: 2013 Drug Name Specialty divalproex
Page 22 and 23: 2013 Drug Name Specialty neomycin/p
Page 24 and 25: 2013 Drug Name Specialty BREATHERIT
Page 26 and 27: 2013 captopril.....................
Page 28 and 29: 2013 hydrochlorothiazide tabs......
Page 30 and 31: 2013 oxybutynin....................
Page 32: 2013 X XALKORI.....................

Generics Plus Formulary - Blue Cross Blue Shield of Illinois

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