Blue Cross and Blue Shield of Montana (BCBSMT) drug lists, are provided as a guide to help in the selection of cost-effective drug therapies. The drug list information below applies to members with prescription drug coverage through BCBSMT, covering such health plans as including individual and employer-offered plans, Medicare and Medicaid government plans and metallic plans offered on and off the Montana Health Insurance Marketplace.
Drug Evaluation and Selection
BCBSMT uses the Prime Therapeutics National Pharmacy and Therapeutics (P&T) Committee to review and evaluate new drugs based on safety, efficacy and cost. In addition to lists of approved drugs, the drug lists also describe how drugs are selected, coverage considerations and dispensing limits. (Complete details, including benefits, limitations and exclusions, are included in the members' benefit materials.)
While providers are encouraged to refer to the BCBSMT Drug Lists when prescribing for our members, we understand that the final decision about what medications should be prescribed is between the health care provider and the patient.
Pharmacy Benefit Management
BCBSMT uses Prime Therapeutics LLC, as its pharmacy benefit manager (PBM) to administer certain core pharmacy services. Prime’s pharmacy benefit management services include:
- Processing and paying Rx claims
- Developing and maintaining the drug list
- Contracting with pharmacy networks
- Verify what drugs are on the drug list by using the , or review the current lists below.