Prescription Drug Lists (Formularies)

A drug list, also known as a formulary, is a list of preferred drugs available to Blue Cross and Blue Shield of Illinois (BCBSIL) members. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. These prescription drug lists have different levels of coverage, which are called "tiers". Generally, if you choose a drug that is a lower tier, your out-of-pocket costs for a prescription drug will be less. Your doctor should consult the Drug List when prescribing drugs for you. This may help lower your out-of-pocket costs.

If you are a BCBSIL member, log in to your Blue Access for MembersSM account to learn more about your prescription drug benefits. Be sure to review your benefit materials for details. If you have any questions about your prescription drug benefits, call the Pharmacy Program number on the back of your member ID card.

Prescription Drug Lists (Formularies) for Metallic Individual Plans

The drug lists below are used with your health plan if all of these apply to you:

  • You enrolled in a plan on your own (instead of through your employer) and
  • Your plan is a "metallic" health plan, which can include a Platinum, Gold, Silver, Bronze, Multi-State or Catastrophic plan.

Your prescription drug benefits through BCBSIL is based on a Drug List, which is a list of drugs considered to be safe and cost-effective.

View your drug list effective January 1, 2017:

Starting January 1, 2017, some changes will be made to the prescription drug benefit. View the 2017 changes.

View your current drug list:

Starting January 1, 2016, some changes will be made to the prescription drug benefit. View the 2016 changes.

You, your prescribing health care provider, or your authorized representative, can ask for a Drug List exception if your drug is not on (or is being removed from) the Drug List (also known as a formulary), or the drug required as part of step therapy or dispensing limits has been found to be (or likely to be) not right for you or does not work as well in treating your condition. To request this exception, you, your prescriber, or your authorized representative, can call the number on the back of your ID card to ask for a review. BCBSIL will let you, your prescriber (or authorized representative) know the coverage decision within 72 hours after they receive your request. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable).

If you have a health condition that may jeopardize your life, health or keep you from regaining function, or your current drug therapy uses a non-covered drug, you, your prescriber, or your authorized representative, may be able to ask for an expedited review process. BCBSIL will let you, your prescriber (or authorized representative) know the coverage decision within 24 hours after they receive your request for an expedited review. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable). Call the number on the back of your ID card if you have any questions.

Prescription Drug Lists (Formularies) for Grandfathered Individual Plans

The drug list below is used with your health plan if all of these apply to you:

  • You enrolled in a plan on your own (instead of through your employer),
  • Your current BCBSIL policy was effective before January 1, 2014, and
  • Your plan is not a "metallic" health plan.

Your prescription drug benefits through BCBSIL is based on the Standard Drug List, which is a list of preferred drugs considered to be safe and effective:

View your current drug list:

Prescription Drug Lists (Formularies) for Employer-offered Plans: Large Group (51 or more)

The drug lists below are used for BCBSIL health plans that are offered through your employer. If your company has 51 or more employees, your prescription drug benefits through BCBSIL may be based on the Standard Drug List or the Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for the major drug classes.

If you have a non-grandfathered health plan offered by your employer, some changes may be made to your prescription drug benefit through BCBSIL for 2017. See more information on these 2017 Prescription Drug Benefit Changes.

If you have a non-grandfathered health plan offered by your employer, some changes may be made to your prescription drug benefit through BCBSIL for 2016. See more information on these 2016 Prescription Drug Benefit Changes.

View your current drug list:

Prescription Drug Lists (Formularies) for Employer-Offered Metallic Plans: Small Group (1–50)

The drug lists below are used with BCBSIL "metallic" health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans.

If your company has 1–50 employees, your prescription drug benefits through BCBSIL are based on a Drug List, which is a list of drugs considered to be safe and effective.

View your drug list effective January 1, 2017:

Starting January 1, 2017, some changes will be made to the prescription drug benefit. View the 2017 changes.

View your current drug list effective January 1, 2016:

Starting January 1, 2016, some changes will be made to the prescription drug benefit. View the 2016 changes.

Want to know which drug list your Illinois Health Insurance Marketplace plan uses?

You, your prescribing health care provider, or your authorized representative, can ask for a Drug List exception if your drug is not on (or is being removed from) the Drug List (also known as a formulary), or the drug required as part of step therapy or dispensing limits has been found to be (or likely to be) not right for you or does not work as well in treating your condition. To request this exception, you, your prescriber, or your authorized representative, can call the number on the back of your ID card to ask for a review. BCBSIL will let you, your prescriber (or authorized representative) know the coverage decision within 72 hours after they receive your request. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable).

If you have a health condition that may jeopardize your life, health or keep you from regaining function, or your current drug therapy uses a non-covered drug, you, your prescriber, or your authorized representative, may be able to ask for an expedited review process. BCBSIL will let you, your prescriber (or authorized representative) know the coverage decision within 24 hours after they receive your request for an expedited review. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable). Call the number on the back of your ID card if you have any questions.

Prescription Drug Lists (Formularies) for Employer-offered Non-Metallic Plans: Small Group (1–50)

The drug lists below are used for BCBSIL health plans that are offered through your employer. These health plans are not a "metallic" health plan and were effective before January 1, 2014.

If your company has 1–50 employees, your prescription drug benefits through BCBSIL may be based on a Standard Drug List or a Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for the major drug classes.

View your current drug list: