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MedicareBlue Solutions health plans are available in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming

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Comprehensive Formulary (PDF)

MedicareBlue Rx Plan Selector

MedicareBlue Rx Plan Selector

The MedicareBlue Rx Plan Selector will help you choose the most appropriate drug plan by comparing formulary status, estimated costs, and projected savings of our three MedicareBlue Rx drug plans.

Order a Printed Drug Formulary

To order a printed comprehensive drug formulary, call one of the Customer Service numbers below:

MedicareBlue PPO: 1-866-434-2038
TTY/TDD: 1-866-456-1550

MedicareBlue Rx: 1-866-434-2037
TTY/TDD: 1-866-456-1550

Assistance is available 8:00 a.m. to 8:00 p.m., daily, Central and Mountain Time.

What is the drug formulary?

This drug formulary is a list of drugs selected for their value and effectiveness by MedicareBlue PPO and MedicareBlue Rx in consultation with a team of professional health care providers. These drugs represent the prescription therapies believed to be a necessary part of a quality treatment program. MedicareBlue PPO and MedicareBlue Rx will generally cover the drugs listed in the formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed.

How much will I pay for my MedicareBlue PPO or MedicareBlue Rx covered drugs?

In order to receive maximum benefits from your coverage, the drugs you purchase must be included in the formulary and your prescriptions should be filled at one of the more than 60,000 contracted or "network" pharmacies nationwide, where your out-of-pocket cost will be lower than at a non-network pharmacy.

Can the formulary change?

Yes, drugs may be added to or removed from the formulary during the year. If we remove drugs from our formulary or add prior authorization, quantity limits, and/or step therapy restrictions on a drug, or move a drug to a higher level, we will notify members who take the drug at least 60 days before the change becomes effective. We may also notify members when they request a refill, at which time they will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

July 03, 2009

Important Information

This page last updated and accepted by CMS June, 2009.

MedicareBlue PPO is a regional Medicare Advantage Plan with a Medicare contract. MedicareBlue Rx is a regional Medicare Prescription Drug Plan with a Medicare contract. MedicareBlue PPO or MedicareBlue Rx coverage is separately issued by one of the following plans: Wellmark Blue Cross and Blue Shield of Iowa,* Blue Cross and Blue Shield of Minnesota,* Blue Cross and Blue Shield of Montana,* Blue Cross and Blue Shield of Nebraska,* Blue Cross Blue Shield of North Dakota,* Wellmark Blue Cross and Blue Shield of South Dakota,* and Blue Cross Blue Shield of Wyoming.*

*Independent licensees of the Blue Cross and Blue Shield Association.

© 2009. All rights reserved.
R5566_050609_C01 CMS 06/09 RE
S5743_050609_C02 CMS 06/09 RE