BCBS Formulary 2024: Medication Requirements and Lists

The Blue Cross Blue Shield (BCBS) Formulary 2024 is now available, and it's essential to understand the medication requirements and lists. The formulary is a list of medications that are covered by BCBS, and it's updated annually.

The BCBS Formulary 2024 includes over 1,000 medications, including brand-name and generic options. These medications have been carefully selected to provide the best possible treatment options for BCBS members.

To be covered under BCBS, medications must be listed on the formulary, and they must also meet certain requirements, such as being FDA-approved and having a proven track record of effectiveness.

To access the drug list for your BCBS plan, you'll need to choose the state where your health plan is located, not where you reside. This is because the drug list may vary depending on the state.

If you're not sure which state to choose, check with your employer or look for the Pharmacy Member Services number on your ID card.

To access the prescription drugs covered by your plan, you can choose your state to search or download Anthem Blue Cross and Blue Shield drug lists. These lists include details about brands and generics, dosage/strength options, and information about prior authorization of your drug.

You can also log in to your account and automatically connect to the current drug list that applies to your pharmacy benefits. If you're not sure which list applies to your plan, check with your employer or call the Pharmacy Member Services number printed on your ID card.

The National Direct drug list is for members who receive a health insurance plan from an employer. This list includes drugs that have been chosen based on their safety, cost, and effectiveness.

To find out if a prescription drug is covered by your plan, it's best to log into BAM and click on the Pharmacy tab. There, you can search a medication and get all the details you need.

If you're part of a small employer group with 1-50 employees, your prescription plan is likely tied to a "metallic" health plan, which includes Platinum, Gold, Silver, or Bronze options.

These plans are used if you enrolled through your employer and have a metallic plan, which is a specific type of health insurance plan.

To review your 2024 plan year prescription benefits, you can check out the 2024 Plan Year – Effective Jan. 1, 2024 section, which lists the different types of drug lists available.

The 2024 Plan Year section notes that there are four types of drug lists: Drug List, Contraceptive Coverage List, Preventive Drug List* for Select HDHP-HSA Plans, and ACA Preventive Drug List.

If you're looking at the 2023 Plan Year and Off-Cycle 2024 Renewals section, be aware that the drug list coverage ended December 31, 2023, except for plans with an off-cycle 2024 renewal date.

Here are the specific plans that have a Preventive Drug List for HDHP-HSA Plans: Blue Focus Bronze POS 002, Blue Focus Gold POS 101, Blue Focus Silver POS 003, Blue Focus Silver POS 101, Blue Preferred Bronze PPO 134, Blue Preferred Gold PPO 101, Blue Preferred Gold PPO 123, Blue Preferred Gold PPO 135, Blue Preferred Silver PPO 101, Blue Preferred Silver PPO 122, Blue Preferred Silver PPO 127, and Blue Preferred Silver PPO 136.

To get the medication you need, your doctor may need to request prior approval from your local BCBS company for certain select drugs.

Your health care provider can request prior approval by contacting your local BCBS company.

If you're unsure which list applies to your plan, check with your employer or call the Pharmacy Member Services number printed on your ID card.

You can also log in to access the current drug list that applies to your pharmacy benefits if you're a member with Anthem's pharmacy coverage.

Drugs on your drug list are chosen based on their safety, cost, and how well they work.

The National Direct drug list is for members who receive a health insurance plan from an employer.

To find out if a prescription drug is covered by your plan, it's best to log into BAM and click on the Pharmacy tab.

You can search a medication and get all the details you need.

Some medications require review or pre-approval before they can be prescribed.

The Multi-Tier Enhanced Drug List and 2025 Drug List are available for review.

You can also check out a summary of the latest drug list changes.

Your medication list is a crucial part of your BCBS formulary 2024 plan. It includes drugs that are covered by your plan and reviewed regularly by a group of doctors and pharmacists.

This list is reviewed regularly to ensure that you have access to the most effective and safe medications for your needs.

Your medication list is an essential tool to help you manage your prescriptions and stay healthy.

Drugs covered by your health plan are reviewed regularly by a group of doctors and pharmacists to ensure their safety and effectiveness.

A two-tiered generic medications benefit design is a smart way to save money on prescription meds. This design features a generic drug list with two levels of member cost-share amounts for generic prescription medications.

The two-tiered system provides an incentive for you to request lower-cost generic medications from your healthcare provider whenever possible. This can lead to significant cost savings over time.

The two-tier generic drug list is designed to encourage the use of lower-cost generic medications. By doing so, you'll be taking a proactive step towards managing your medication costs.

Viewing the Two-Tier Generic Drugs list is a great way to get started.

Specialty medications are a crucial part of many treatment plans, and BCBS has made some notable changes to its formulary in 2024.

BCBS has added several new specialty medications to its formulary, including a new treatment for multiple sclerosis, which will be covered with a 20% coinsurance for members.

These medications are often more expensive than traditional prescription drugs, but they can be a lifesaver for people with complex or chronic conditions.

Preventive Rx is a benefit that's included in some BCBS plans, allowing members to receive certain preventive drugs at low or no cost.

These lists of covered preventive drugs are called PreventiveRx Drug Lists, and they apply specifically to members whose plans include this benefit.

These lists are designed to help members stay healthy and prevent illnesses, rather than just treating them after they've occurred.

To get the prescription drugs you need, your healthcare provider may need to request prior approval from your local BCBS company. This is required for select drugs.

You can get the full list of these select drugs by downloading it from the relevant website. Your healthcare provider can contact your local BCBS company to request prior approval.

Your health plan may also require preauthorization for certain drugs, which your doctor will need to complete a form for. You can view the list of medications requiring preauthorization on the relevant website.

If you're a member with Anthem's pharmacy coverage, you can log in to access the current drug list that applies to your pharmacy benefits.

Some prescription drugs and supplies need prior approval when using your pharmacy benefits, and your healthcare provider can request this approval electronically, by fax, or by mail.

Your healthcare provider needs to confirm two things: that you're using the drug to treat something your plan covers and that your healthcare provider prescribes it in a medically appropriate way.

The full list of drugs that need prior approval can be downloaded here, and your healthcare provider will need to fill out the prior approval form.

There are equivalents for drugs that are not covered on your plan's drug list, and you can see the list of what's not covered and available alternative options by choosing your state to search or download Anthem Blue Cross and Blue Shield drug lists.

If you're a member with Anthem's pharmacy coverage, you can log in to automatically connect to the current drug list that applies to your pharmacy benefits.

If your health plan is located in a state where you don't reside, you should choose the state of your health plan to access the correct drug list.

Medicare is a federal health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). It's administered by the Centers for Medicare and Medicaid Services (CMS).

Eligible individuals can enroll in Medicare in various ways, including directly through the Social Security Administration (SSA) or Medicare.gov. The initial enrollment period typically lasts seven months, starting three months before the birthday month and ending three months after.

Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Each part has different costs and benefits, but they all aim to provide comprehensive coverage for eligible individuals.

If you're looking for a health plan through your employer, you'll want to know about the different plan options available.

There are metallic plans, which include Platinum, Gold, Silver, and Bronze health plans. These plans are only available to employers with between 1 and 50 employees.

To be eligible for a metallic plan, your employer must have between 1 and 50 employees, and you must enroll in the plan through your employer.

Here are the different types of plan lists available for small employer groups:

Note that the Preventive Drug List only applies to specific plans, including Blue Focus Bronze POS 002 and Blue Preferred Silver PPO 127.

You can take a different medication if the one prescribed is not on the FEP Blue Standard or FEP Blue Basic drug list, because there are equivalents available.

FEP Blue Focus members can apply for coverage of a drug not covered on their list through the Non-Formulary Exception Process (NFE) form.

The list of what's not covered and available alternative options can be seen by FEP Blue Standard and FEP Blue Basic members.

The Step Therapy Program is a process used by some health insurance plans to ensure that patients are taking the most cost-effective medication for their condition. This program is designed to encourage patients to try less expensive medications before moving on to more expensive ones.

A Multi-Tier Basic Drug List is often used in Step Therapy Programs to categorize medications by cost and effectiveness. The 2025 Drug List, for example, is a specific list of medications that may be used in a Step Therapy Program.

The Step Therapy Program requires patients to try a less expensive medication, such as one on the Multi-Tier Basic Drug List, before their insurance plan will cover a more expensive one. This can be frustrating for patients who need a specific medication to manage their symptoms.

The Updates Summary for the 2025 Drug List provides information on changes to the list, including the addition or removal of medications. This information can be helpful for patients and healthcare providers who need to stay up-to-date on the latest medication options.

If you're taking a medication that's not on your plan's list, don't worry, there are alternatives available. You can see a list of unlisted medications and available alternatives for FEP Blue Standard and FEP Blue Basic plans.

FEP Blue Focus members have the option to apply for coverage of a drug not covered on their plan with the Non-Formulary Exception Process form.