Prescription Drug Lists (Formularies)

A prescription drug list, or formulary, is a list of preferred drugs available to Blue Cross and Blue Shield of Montana (BCBSMT) members. These drugs are considered to be safe and cost-effective. Medications not listed on the formulary may require you to pay more out-of-pocket. Within a drug list, generally the lower the tier, the lower the cost of the drug.

If you are a BCBSMT member, log in to your Blue Access for MembersSM account to learn more about your prescription drug benefits. Be sure to review your benefit materials for details. If you have any questions about your prescription drug benefits, call the Pharmacy Program number on the back of your member ID card.

Prescription Drug Lists (Formularies) for Metallic Individual Plans

The drug lists below are used with your health plan if all of these apply to you:

  • You enrolled in a plan on your own (instead of through your employer) and
  • Your plan is a "metallic" health plan, which can include a Gold, Silver, Bronze, Multi-State or Catastrophic plan.

Your prescription drug benefits through BCBSMT is based on a Drug List, which is a list of preferred drugs considered to be safe and cost-effective.

View your drug list effective January 1, 2017:

Starting January 1, 2017, some changes will be made to the prescription drug benefit. View the 2017 changes.

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.

If you're already a BCBSMT member, log in to Blue Access for MembersSM to learn more about your pharmacy benefits.

Prescription Drug Lists (Formularies) for Employer-offered Plans: Large Group (51 or more)

The drug lists below are used for BCBSMT health plans that are offered through your employer. If your company has 51 or more employees, your BCBSMT prescription drug benefits may be based on the Basic (previously named Standard) Drug List, the Enhanced (previously named Generics Plus) Drug List, the Performance Drug List or the Performance Select Drug List. These drug lists are a continually updated list of covered drugs.

If you have a non-grandfathered health plan offered by your employer, some changes may be made to your prescription drug benefit through BCBSMT for 2017. See more information on these 2017 Prescription Drug Benefit Changes.

View your current drug list:

If you're already a BCBSMT member, log in to Blue Access for MembersSM to learn more about your pharmacy benefits.

Prescription Drug Lists (Formularies) for Employer-Offered Metallic Plans: Small Group (1–50)

The Drug Lists below are used with BCBSMT "metallic" health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans.

If your company has 1-50 employees, your prescription drug benefits through BCBSMT are based on a Drug List, which is a list of drugs considered to be safe and cost-effective.

View your drug list effective January 1, 2017:

Starting January 1, 2017, some changes will be made to the prescription drug benefit. View the 2017 changes.

These drug lists coverage ended December 31, 2016, with the exception of a plan with an off-cycle 2017 renewal date. (Check your benefit materials for details.):

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.

If you're already a BCBSMT member, log in to Blue Access for MembersSM to learn more about your pharmacy benefits.

Prescription Drug Lists (Formularies) for Employer-offered Non-Metallic Plans: Small Group (1–50)

The drug lists below are used for BCBSMT health plans that are offered through your employer. These health plans are not a "metallic" health plan and were effective before January 1, 2014.

If your company has 1–50 employees, your BCBSMT prescription drug benefits may be based on the Basic (previously named Standard) Drug List or the Enhanced (previously named Generics Plus) Drug List. These drug lists are a continually updated list of covered drugs.

View your current drug list:

If you're already a BCBSMT member, log in to Blue Access for MembersSM to learn more about your pharmacy benefits.