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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     EfficientRx/Generics Plus

 

    
  • Provider: Prime Pharmacy Policy and PA forms

     

  • 2014 On and Off Exchange Formularies: Coverage begins January 1, 2014 (Platinum, Gold, Silver, Bronze, Multi-State, Catastrophic Plans)

     

    Want to know which formulary your plan uses? Use the one of the charts below:

  • Look up which Formulary is used with Individual Health Plans
  • Look up which Formulary is used with Small Group Plans 

       

  • Provider: 2014 On and Off Exchange PA forms

    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. 

         More...

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

         More...
      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. 

         More...

    Program summary and prior authorization specialty forms.

         More...


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

     
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