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Preferred Medications (Formulary)

BCBSMT uses a custom list of preferred and non-preferred medications called a formulary.  The formulary is reviewed and maintained by a group of physicians and pharmacists.

Verify what drugs are on the formulary by using the Find a Drug tool, or review the current lists below.
  
 TraditionalRx/Standard     EfficientRx/Generics Plus
Provider: Prime Pharmacy Policy and PA forms

Glucose Meter Offer
BCBSMT offers blood glucose meters to members with diabetes at no additional charge to help you manage your condition.  This offer is available through December 31, 2015.  See the glucose meter flier for more information about this offer and monitoring your blood glucose level. Members with BCBSMT prescription drug coverage should check the Drug List to see which test strips for the meters offered are listed as preferred brands.  Coverage and payment levels for test strips may vary depending on your pharmacy benefit plan.
  
2015 On and Off Exchange Drug Lists (also known as a Formulary): Coverage begins January 1, 2015 (Platinum, Gold, Silver, Bronze, Catastrophic Plans)
  
Want to know which drug list your plan uses? Use one of the charts below:

Information on Non-Covered Drugs on Exchange Products: You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List (also known as formulary).  To request this exception, you, or your prescriber, can call the number on the back of your ID card to ask for a review.  If you have a health condition that may jeopardize your life, health, keep you from regaining function, or your current drug therapy uses a non-covered drug, you or your prescriber may be able to ask for an expedited review process.  BCBSMT will let you, and your prescriber know the coverage decision within 24 hours after they receive your request for an expedited review.  If the coverage request is denied, BCBSMT will let you and your prescriber know why it was denied and offer you a covered alternative drug (if applicable).  Call the number on the back of your ID card if you have any questions.

2014 On and Off Exchange Formularies: Coverage began January 1, 2014 (Platinum, Gold, Silver, Bronze, Plans)
  

 

Want to know which formulary your plan uses? Use the chart below: 

Provider: 2015 On and Off Exchange PA forms

BCBSMT 2015 Marketplace Standard UM Program Overview, click here for details. This document will help you determine which prior authorization form is used for the medication being prescribed.

Download Prior Authorization and Step Therapy fax forms from the Prime Therapeutics website using the following links:

If you have questions or concerns regarding these programs, please call Prime Therapeutics at 888-723-7443.

Pharmacy Benefits

Prime Therapeutics LLC (Prime) is an independent Pharmacy Benefit Manager (PBM) chosen by Blue Cross and Blue Shield of Montana (BCBSMT) to manage your prescription drug benefit.  The links below are intended to provide any necessary information regarding your prescription drug benefit.

Women's Contraceptive Drug List

Vaccine Program
If you have coverage through Blue Cross and Blue Shield of Montana, vaccinations may be covered under the medical benefit or prescription drug benefit, based on your plan. Select vaccines can be conveniently administered at a pharmacy near you. These vaccines can help protect you and your covered family members from illnesses such as the flu, pneumonia, shingles, meningitis, HPV, diphtheria and tetanus.

To see which vaccines are covered under your plan, check your benefit materials for details and any necessary copays. Or, you can call the Pharmacy Program number on the back of your ID card.

  • The select vaccines covered under the prescription drug benefit are conveniently administered at a participating vaccine network pharmacy. Just hand your ID card to the pharmacist.
  • To find a participating pharmacy near you, see the list of Montana participating pharmacies, a national list of participating pharmacies, or you can call the number on the back of your ID card.
  • Before you go, be sure to confirm the location’s participation and hours, vaccine availability and ask about any other age limits, restrictions or requirements that may apply.

Understanding Preventative Health Services

Direct Access to Your Drug Claim Information
All registered members of our Online Services may login to our site and gain immediate access to MyPrime.com and MyPrimeMail.com.

  • MyPrime.com provides information and tools to assist our members with their prescription drug benefits including pharmacy related forms, an up-to-date formulary list, Prime pharmacy locator and history of your drug claim information.
  • MyPrimeMail.com provides information and tools to help you use your mail-service benefit through PrimeMail.

Once logged into our site, select My Pharmacy in the links area located above your eligibility information.  This link will route you directly to MyPrime.com via Prime Therapeutics.  If you are not a registered member, visit our Register Now area for instructions.  Registration is easy and will give you immediate access to your BCBSMT and pharmacy information.

Participating Pharmacy Network    Mail Order Pharmacy Services 
Prime contracts with over 59,000 pharmacies nationwide to ensure that our members have access to participating pharmacies.  To find a participating pharmacy near you, use the link below:
    Find a Pharmacy
 

BCBSMT offers our members two choices for pharmacy mail order services. 

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Submitting Claims   Specialty Pharmacy
If your drug claim was not processed electronically by your pharmacy, you can submit a claim for reimbursement. 

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  Click below for more information about Prime Specialty Pharmacy, Prime's current specialty pharmacy program. 

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Pharmacy Prior Authorization & Step Therapy Prime Pharmacy Policy
Some medications require prior authorization before they can be prescribed. 

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Program summary and prior authorization specialty forms.

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E-Prescribing for Providers
Learn more about e-prescribing.

 
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