Prescription Drug Information
Which Prescription Drugs Are Covered
A formulary is a list of preferred drugs that are considered safe and effective. The list includes most generic medications and many brand-name medications. Remember that choosing drugs that are on this list can save you money.
- Is your medication is on the list? Be sure to check the formulary to see if the prescription drugs you take are on the list.
- If you don’t see your medication on the list, you might want to talk to your doctor to see if there are other options. A generic or lower-cost brand-name drug that is on the formulary might work just as well for you, and may save you money.
Note that some drug classes (for example, Erectile Dysfunction drugs) 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 1-877-217-7986 to talk to a Customer Advocate.
Where To Fill Your Prescription
To use your prescription drug benefits:
- Find a contracting pharmacy near you and show them your member ID card.
Attention Walgreens Team Members and Sears Holdings associates — Please note, a specific pharmacy network is available to you and is different than what will appear on this pharmacy search tool. Please call 1-877-217-7986 for additional information.
- For maintenance medications, you can use PrimeMail® and have a 90-day supply of medication sent right to your home. Your plan may also allow you to fill a 90-day supply of your maintenance medication(s) at a contracting pharmacy. Be sure to check your plan documents to verify.
Please note: Your employer may offer a mail order service other than PrimeMail. Log in to Blue Access for Members to find the forms that specifically apply to your coverage under the "Forms and Documents" tab.
Medications That Must Be Preapproved: Prior Authorization Program
Under the Prior Authorization Program, your doctor has to get approval from Blue Cross and Blue Shield of Illinois before your prescription drug plan will cover certain medications and drug categories. This program helps manage the rising costs of prescription drugs and promotes the safe use of medications.
Medications That Require a Prescription History: Step Therapy Program
The Step Therapy Program encourages safe, cost-effective medication use by requiring you to have a prescription history for a "first-line" medication before your benefit plan will cover a "second-line" drug.
- A first-line drug is recognized as safe and effective in treating a specific medical condition, as well as being a cost-effective treatment option.
- A second-line drug is a less-preferred or potentially more costly treatment option.
If you are a current Blue Cross and Blue Shield of Illinois member and have recently gone through the Step Therapy Program, you do not have to complete it again.
Other Special Requirements and Limitations
Certain medications have special rules for coverage which may include:
- Higher out-of-pocket costs for name-brand drugs that have equally effective generic or over-the-counter versions
- Requirements around specialty medications used to treat complex medical conditions
- Restrictions on how much of a drug you can get at once and how often you can get that prescription refilled