Prescription Drug List 


A prescription drug list is a list of drugs available to Blue Cross and Blue Shield of Montana (BCBSMT) members. These drugs are considered to be safe and cost-effective. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. These drug lists have different levels of coverage, which are called “tiers”. Generally, if you choose a drug that is a lower tier, your out-of-pocket costs for a prescription drug will be less. Your doctor should consult the Drug List when prescribing drugs for you. This may help lower your out-of-pocket costs.

Some things to know:
  1. Based on your benefits, if you use a drug manufacturer’s coupon or copay card to pay for a covered prescription drug, this amount may not apply to your plan deductible or out-of-pocket maximum.
  2. Health plans may administer medical and pharmacy coverage separately for select drugs. Some drugs are covered under your medical plan instead of your pharmacy benefits. These can include drugs that must be given to you by a health care provider. These drugs are often given to you in a hospital, doctor’s office or health care setting. Examples of these drugs are contraceptive implants and chemo infusion. If you are taking or prescribed a drug that is not on your plan's Drug List, call the number on your member ID card to see if the drug may be covered by your medical plan.

If you are a BCBSMT member, log in to your Blue Access for MembersSM  account to check your drug list and 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 number listed on your member ID card.

  • Prescription Drug Lists for Metallic Individual Plans

    The drug lists below are used with your health plan if:

    • 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 or Catastrophic plan.

    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.

    To search for a drug name within the PDF Drug List document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking for and click on Search.

    View your drug list effective January 1, 2023:

    Starting January 1, 2023, some changes will be made to the prescription drug benefit. Review the 2023 changes.

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

    You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List. 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 listed on your member ID card if you have any questions.

     

  • Prescription Drug Lists 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 one of the following drug lists. These drug lists are a continually updated list of covered drugs.

    If you are a BCBSMT member, log in to your Blue Access for MembersSM  account to check your drug list and learn more about your prescription drug benefits.

    View your drug list effective January 1, 2023:

     

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


    The drug lists below are used for 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 BCBSMT prescription drug benefits are based on a Drug List, which is a list of drugs considered to be safe and cost effective.

    If you are a BCBSMT member, log in to your Blue Access for MembersSM  account to check your drug list and learn more about your prescription drug benefits.

    View your drug list effective January 1, 2023:

    Starting January 1, 2023, some changes will be made to the prescription drug benefit. Review the 2023 changes.

    This drug list coverage ended December 31, 2022, with the exception of a plan with an off-cycle 2023 renewal date. (Check your benefit materials for details.)

    Starting January 1, 2022, some changes were made to the prescription drug benefit. Review the 2022 changes.

    You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List. 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 listed on your member ID card if you have any questions.

Last Updated: Dec. 30, 2022