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Prescription Drugs

Check these documents and your Summary Plan Description (SPD) 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 save you money.

Note that some drug classes (for example, Proton Pump Inhibitors) are 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 1-800-203-3765 to talk to a Customer Advocate.

Where to Fill Your Prescriptions

To use your prescription drug benefits:

  • Find a contracting pharmacy near you and show them your member ID card.
  • For maintenance medications, you can have a 90-day supply sent right to your home. Your plan also allows you to fill a 90-day supply of your covered maintenance medication(s) at a contracting pharmacy. Be sure to check your benefits materials to verify.

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

Estimate Prescription Drug Prices

You can find out how much your prescription drugs cost and learn how to keep costs down at MyPrime.

Free Blood Glucose Meter Offer

Blue Cross and Blue Shield of Illinois (BCBSIL) offers certain blood glucose meters to members with diabetes at no additional charge.

Other Special Requirements and Limitations

Certain medications have special rules for coverage which may include:

  • Medications that must be preapproved
  • Medications that require a prescription history
  • Requirements around specialty medications used to treat complex medical conditions
  • Higher out-of-pocket costs for name-brand drugs that have equally effective generic
  • 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 rules might affect you