Understanding Bcbs Health Select Formulary Drug Coverage

The BCBS Health Select Formulary is a list of prescription drugs that are covered by Blue Cross Blue Shield (BCBS) health insurance plans. This list is constantly updated to reflect the latest medical research and treatments.

BCBS Health Select Formulary covers a wide range of medications, including brand-name and generic drugs. It also includes medications for various health conditions, such as diabetes, high blood pressure, and asthma.

Some medications may require prior authorization before they can be prescribed. This means that your doctor will need to request approval from BCBS before you can receive the medication.

BCBS Health Select Formulary also has a process for appealing denied claims. If your claim is denied, you can file an appeal and provide additional information to support your case.

Drug management is a crucial aspect of your BCBS Health Select formulary. Your plan may include programs to help manage your prescription medications, which can help you save money and stay healthy.

You should always consider generic drugs for the lowest out-of-pocket expense, especially if your doctor decides they're right for you. Generic drugs are usually the most cost-effective option.

If you take maintenance drugs for a chronic condition or routine products like birth control pills, you may be able to fill prescriptions for 90 days at a time. Check your member guide for details on this requirement.

Your plan may also have programs in place to help fight the national opioid crisis, including daily quantity limits and prior authorization requirements for certain prescribing situations. This can help prevent overuse of opioid medications.

Here are some common drug management programs you might find in your plan:

Drug Tiers are a way for your health insurance plan to categorize prescription drugs based on cost and availability. Each drug is assigned a tier, which determines how much you'll pay out-of-pocket.

The tiers are designed to encourage you to choose the most cost-effective option. If you and your doctor decide a generic drug is right for you, it's always the lowest-cost choice.

Generic drugs are usually the lowest-cost option, and you should always consider them first. They're often just as effective as brand-name drugs, but at a lower price point.

Preferred Brand drugs are the next step up in cost, but they're still a more affordable option than Nonpreferred Brand drugs. These are usually brand-name drugs that don't have a generic equivalent.

Nonpreferred Brand drugs are typically the highest-cost option, and they're usually brand-name drugs that have a generic equivalent. When a generic becomes available, the brand-name version will often move to Nonpreferred status.

Specialty drugs are often the most expensive option, and they're usually used to treat complex or chronic conditions.

Drug management programs can be complex, but understanding the basics can help you navigate the process. Not all members have all of these programs, so it's essential to check your Schedule of Benefits to see which ones apply to you.

Prior authorization is usually required for certain drugs, and most members need it. This means you'll need to get approval from your plan before filling a prescription for those specific medications.

Quantity management limits the amount of certain drugs your plan will cover. This can help prevent overuse or misuse of certain medications.

Step therapy requires you to try one or more Step 1 drugs before your plan will cover Step 2 drugs. If you're unsure which programs apply to you, speak with your human resources department or refer to your benefit document.

Here are the three main drug management programs in a quick reference format:

You might be surprised to know that your insurance plan can change its coverage of certain medications over time. This happens when a pharmacy committee decides to no longer cover a drug because there are safer, more effective, and less costly alternatives available.

Nonformulary drugs are those that your plan no longer covers. These drugs are often moved to nonformulary status when better options become available.

You and your doctor always have the freedom to choose the medication that works best for you, even if it's not covered by your plan. Some plans may exclude coverage for certain categories of drugs, such as those for weight loss, fertility, or sexual dysfunction.

Some examples of excluded categories include:

Keep in mind that your plan may have different rules and exclusions, so it's always a good idea to check your Schedule of Benefits for more information.

You can fill your prescriptions for maintenance drugs for 90 days at a time. This can be a convenient option for long-term treatments.

Some health plans require 90-day fills for maintenance drugs, so be sure to check your member guide for details. This can help you plan ahead and avoid unnecessary trips to the pharmacy.

Maintenance drugs are prescription drugs you take on a long-term basis, often to treat chronic conditions or taken routinely, like birth control pills.

Taking preventive drugs, as directed by your doctor, may help you live a healthier life today and avoid serious illness in the future.

Under the Affordable Care Act, most health plans are required to cover certain preventive drugs at $0 cost to members.

Preventive care, including prescription medications used for preventive purposes, can be excluded from the deductible under IRS guidelines for high-deductible health plans.

Talk to your benefits coordinator to learn if your plan offers this benefit, and explore the options available to you.

Preventive drugs can be a game-changer for your health, and the good news is that many health plans now cover them at no cost to members.

These drugs are designed to prevent serious illnesses and complications, and taking them as directed by your doctor can help you live a healthier life today and avoid serious illness in the future.

Under the Affordable Care Act, most health plans are required to cover certain preventive drugs at $0 cost to members. This is a huge benefit that can save you money and reduce your risk of serious health problems.

Your benefits coordinator can tell you if your plan offers this benefit, so be sure to reach out to them for more information.

Maintenance drugs are prescription drugs you take on a long-term basis. They may be used to treat a chronic condition.

Some examples of maintenance drugs include birth control pills, which are taken routinely. These products often have prescriptions that can be filled for 90 days at a time.

Some health plans require 90-day fills for maintenance drugs. Check your member guide for details.