Drug Coverage

The Blue Cross Community MMAI plan includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. The Drug List (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. This list includes generic and brand drugs and medical supplies. It also includes the drugs covered by Medicare Part D.

View the Drug List PDF Document

You can also search the list by visiting MyPrime .

As a member, you may have a co-pay for some of the items on the Drug List, depending on your income level and institutional status. Please see Drug Information section below for more information. Your plan covers the items in the Drug List as long as you:

  • Have a medical need for them
  • Have a prescription from your doctor for them
  • Fill the prescription at a network pharmacy
  • Follow the plan rules

Personal health-related items (such as a toothbrush and toothpaste) are not included on this list. However, you can order these items once every three months. The plan will pay up to $30 (plus $5 for shipping) for each order. If you do not use the $30, it does not roll over into the next three months. You can get one shipment every three months. To see if you are eligible, call 1-877-860-2837. See Chapter 4 of the Member Handbook PDF Document for more details.

Certain drugs on the list need prior authorization. Your doctor will need to request approval before these drugs can be prescribed. Without approval, the drug won't be covered. Talk with your doctor about your medication. Your doctor will choose which drug is best for you. If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug. For some drugs, the plan limits the amount that will be covered. You can find out if your drug has any added conditions or limits by looking at the Drug List.

To protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs.








 

Prime Therapeutics LLC is a separate company that provides pharmacy benefit management services for some Blue Cross and Blue Shield of Illinois plans.

 

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