Prescription Drug Benefits

Find out what medications are covered and where you can get your prescriptions filled to maximize your benefits.

Which Prescription Drugs Are Covered

Check these documents and your Benefits Certificate to see if your prescription drugs are covered. The formulary list consists of most preferred generic and many brand-name medications. Choosing drugs from this list may save you money.

If you don't see your medication on the list check with your doctor for a generic or lower-cost option on the formulary that may work just as well and may save you money!

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 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 external icon. Please call 877-217-7986 for additional information.

    If you wish to continue on to the pharmacy search tool, click here.

  • For maintenance medications, you can have a 90-day supply sent right to your home. Your plan may also allow you to fill a 90-day supply of your covered maintenance medication(s) at a contracting pharmacy. Be sure to check your benefit materials to verify.

    Log in to Blue Access for MembersSM to find the prescription drug forms that specifically apply to your coverage under the "Forms and Documents" tab.

Medications That Must Be Preapproved

Under the Prior Authorization Program, your doctor has to get approval from Blue Cross and Blue Shield before your prescription drug plan will cover certain medications and drug categories.

Check to see if preapproval is needed for your medication

Medications That Require a Prescription History

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.

Check to see if any special requirements apply for your medication

If you are a current 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 generic or over-the-counter versions
  • Requirements around specialty medications used to treat complex medical conditions such as Hepatitis C and multiple sclerosis (MS)
  • Restrictions on how much of a drug you can get at once and how often you can get that prescription refilled at that quantity

Learn how these special rules might affect you
If you are a Walgreens Team Member, you have a different specialty pharmacy. Please call 877-217-7986 for more information.

Continue to Special Requirements and Limitations

Estimate Prescription Drug Prices

You can estimate how much your prescription medications will cost at MyPrime external icon.

Visit MyPrime external icon to find prices for your medications and learn how to keep costs down.