| What
is a formulary?
Can
I use non-formulary drugs?
Can a mail service pharmacy receive
fax prescriptions?
How
much will I pay at the pharmacy?
Who
do I contact if I have questions?
What is a formulary?
The Blue Cross and Blue Shield of Illinois prescription drug
formulary is a list of preferred drugs selected by a panel
of physicians and pharmacists. The formulary includes all
generic drugs and a select group of brand name drugs. All
drugs are evaluated on their comparative efficacy, safety,
uniqueness and cost effectiveness. Blue Cross and Blue Shield of Illinois revises it's formulary on a regular basis to reflect the availability of new prescription drugs and other changes in the pharmacy market.
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Can I use non-formulary
drugs?
Yes. Blue Cross uses an open prescription drug formulary,
which means you have benefit coverage for most drugs, even
if they are not on the formulary. You will, however, pay the
highest copayment or coinsurance level for non-formulary drugs.
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Can a mail
service pharmacy receive faxed prescriptions?
Yes, if a change is made to an existing prescription and
you need a refill immediately, you can provide your doctor
with a Physician’s Fax Form so that he/she can send your prescription
directly to the mail service pharmacy for you. Please note
that the mail service pharmacy will only accept a fax prescription
that is sent directly from your doctor’s office. Prescriptions
faxed for controlled substances will not be processed. You
must mail the original prescription signed by your doctor
to the mail service pharmacy.
How much will I pay
at the pharmacy?
If your benefit plan is based on a three-tier design, your
copayment or coinsurance share will be lowest for generic
medications, the same or slightly higher for brand name drugs
that are on the formulary, and highest for brand name drugs
that are not on the formulary.
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Who do I contact if
I have questions?
As always, you should discuss questions and concerns about
drugs that you are taking with your physician. He or she can
discuss whether a Blue Cross formulary medication is appropriate
for you. If you have any questions about your prescription
drug benefits, call our Prescription Drug Inquiry Unit (800)
423-1973.
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