Pharmacy information Drug Formulary Information
Get the most coverage for your prescription drugs, by using a pharmacy that's in our network. Choose from the following options to find a network pharmacy near you:
Find a Network Pharmacy Near You
- Search for individual members | Employer group members
- Pharmacy directories by state - Get complete information and order online.
- CVS Specialty Pharmacy for MedicareBlue Rx plans:
- Specialty pharmacy focuses on the long-term, complex treatment of chronically ill patients where treatment often involves high cost or complex drugs used to treat complex conditions.
Request a pharmacy directory be mailed to you by calling the appropriate number below or order a hard copy . You can also get help with the most current pharmacy information, obtain the name and address of a network pharmacy.
Drug formulary information | go back
Search a list of prescription drugs covered by our Medicare plans also called a formulary. Choose from the following options:
- Drug search online
- Drug formulary exception forms for non covered drugs.
- Covered Over-the-Counter Insulin and Insulin Administration for non covered drugs.
- How to address non-coverage of a prescription drug if your health care provider or pharmacist tells you they will not cover a prescription drug in your treatment plan.
- Drug formularies for individuals | for employer group plans
- Have a printed copy mailed to you by calling the appropriate number below.
About the drug formulary
Our drug formulary is a list of drugs selected for their value and effectiveness. The list is selected by MedicareBlue Rx in consultation with a team of professional health care providers. The formulary represents prescription therapies believed to be a necessary part of a quality treatment program. 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 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 any of our network pharmacies. However, your costs may be even less for your covered drugs if you use a network pharmacy that offers preferred cost sharing rather than a pharmacy that offers standard cost sharing.
What if my drug is not on the formulary?
Talk to your doctor if your drug isn't on the formulary. He or she may be able to prescribe a different drug for you that is covered by the plan. If an alternative drug is not available or will not be as effective, your doctor can submit a formulary exception form to ask that the drug be covered.
Can the formulary change?
Yes, drugs may be added or removed during the year. If we remove drugs from our formulary or add restrictions to the drug, such as prior authorization, quantity limits and/or step therapy, or move a drug to a higher level in the formulary, we will notify members who take the drug at least 30 days before the change becomes effective. We may also notify members when they request a refill, at which time they would receive a 30-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drugs 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.
About supplemental drugs for group plan members only
If you are a member of a Group MedicareBlueRx plan for employer and union groups, your Part D drugs are listed in the Group Comprehensive Formulary. You also have access to a supplemental drug benefit that helps pay for selected prescription drugs that Medicare does not cover and are not on the formulary. You may purchase drugs on the Supplemental List a 25 percent coinsurance. Please note that the amount you spend on supplemental drugs does not count toward reaching your out-of-pocket maximum for catastrophic coverage. For this reason, we encourage you to talk with your doctor to identify alternate medications that are on the formulary.
If you have questions about the Supplemental Drug list or Group Comprehensive Formulary, please call Customer Service at 1-877-838-3827.
About our pharmacy network for group plan members only
Group MedicareBlue Rx is supported by CVS Caremark.* Once enrolled, you’ll have access to a nationwide network of pharmacies that include major chains as well as neighborhood pharmacies. You may go to any of our network pharmacies. When your covered drug costs less than your copayment or coinsurance amount, you will pay that lower price for the drug. You pay either the full price of the drug or the copayment/coinsurance amount, whichever is lower. Members that use an out-of-network pharmacy, will generally have to pay the full cost (rather than your normal share of the cost) at the time you fill your prescription. You can ask us to reimburse you for our share of the cost.* CVS Caremark Part D Services is an independent company providing pharmacy benefit management services.