Drug Lists for Group Members
Who is this for?
If you have a PPO or HMO health plan through your employer that includes prescription drug coverage, you can use these drug lists (also known as formularies) to see if your Blue Cross Blue Shield of Michigan plan covers a medication.
Employers with more than 50 full-time employees can choose the prescription drug coverage that goes with the health plans they provide. However, not all HMO and PPO plans share the same drug list, or formulary.
To see if a medication is covered, you'll need to know whether your Blue Cross plan uses Preferred, Clinical, Custom or Custom Select Drug Lists. You can find out by checking your prescription drug benefits by logging into your online account. From there, you'll be able to find out what's covered, how much a medication will cost and compare brand-name prescriptions with generics.
If you can't find your drug list, call the customer service number on the back of your member ID card for help.
Some additional resources can be used with most of our group plans. They're listed below under "Other helpful resources."
Preferred drug lists
Preferred Drug List (PDF)
The list of drugs covered by your plan if your plan uses the Preferred Drug List. This drug list is updated monthly.
Preferred Drug List Prior Authorization and Step Therapy Guidelines (PDF)
A list of drugs that need to be approved before your plan will cover them.
Preferred Alternatives for Nonpreferred and Nonformulary Drugs – Preferred Drug List (PDF)
A list of drugs that are nonpreferred or nonformulary (not covered) on the Preferred Drug List. Use this list to find covered alternatives at a lower cost.
Clinical and Custom drug lists
Clinical Drug List (PDF)
The list of drugs covered by your plan if your plan uses the Clinical Drug List. This drug list is updated monthly.
Custom PPO Drug List (PDF)
Custom HMO Tier 3 and Tier 5 Drug List (PDF)
Custom HMO Tier 6 Drug List (PDF)
These documents list drugs covered by your plan if your plan uses the Custom Drug List. This drug list is updated monthly.
Preferred Alternatives for Nonpreferred and Nonformulary Drugs – Custom and Clinical Drug Lists (PDF)
A list of drugs that are nonpreferred or nonformulary (not covered) on the Custom and Clinical Drug Lists. Use this list to find covered alternatives at a lower cost.
Custom Select drug lists
PPO Custom Select Drug List (PDF)
HMO Custom Select Drug List (PDF)
These list drugs covered by your plan if your plan uses the Custom Select Drug List. These drug lists are updated monthly.
Preferred Alternatives for Nonpreferred and Nonformulary Drugs – Custom Select Drug List (PDF)
A list of drugs that are nonpreferred or nonformulary (not covered) on the Custom Select Drug List. Use this list to find covered alternatives at a lower cost.
Drug List Updates
Drug List Updates (PDF)
The latest additions and changes to Blue Cross Blue Shield and BCN’s drug lists.
Quantity Limits
Quantity Limit Program Drug List (PDF)
A list of drugs that have limits on the amount of medication you can fill.
Prior Authorization
Prior Authorization and Step Therapy Guidelines (PDF)
A list of drugs that need to be approved before your plan will cover them.
Preventive Drug Lists
Preventive Drug List (PDF)
A list of preventive drugs that are covered with $0 cost share under the Affordable Care Act. For information specific to your preventive benefits, please check your Blue Cross benefits-at-a-glance or BCN drug rider.
High Deductible Health Plan (HDHP) Preventive Drug Lists
The following preventive care drug lists apply to select high-deductible health plans (HDHPs). If your plan has one of these lists, then you don’t have to meet a deductible before these drugs are covered and you only pay your applicable copay/coinsurance or nothing at all.
HDHP Preventive Drug List (PDF)
A list of preventive drugs used to treat a range of chronic conditions. This list includes, but is not limited to, drugs to help you lose weight, lower your cholesterol, and lower your blood pressure.
HDHP Preventive Drug List with Diabetic Drugs (PDF)
A list of preventive drugs used to treat an increased range of chronic conditions. This list is inclusive of the drugs covered under the HDHP Preventive Drug List but also includes drugs to help you manage your blood sugar.
Expanded HDHP Preventive Drug List (PDF)
A list of preventive drugs used to treat an expanded range of chronic conditions. This list is inclusive of the drugs covered under the HDHP Preventive Drug List with Diabetic Drugs but also includes drugs to help manage emotional/mental health, osteoporosis, and respiratory conditions.
Other helpful resources
Specialty Drug Program Member Guide (PDF)
A list of drugs used to treat complex and chronic illnesses that require special handling. Use this guide to find out more information on your plan’s requirements for filling specialty drugs, to look up your drug, and to find out where and how to fill your prescription.
15-Day Specialty Drug Limitation Program List (PDF)
A list of specialty drugs that have a 15-day supply limit.
Mail Service Saver and Saver90 Drug List (PDF)
A list of maintenance drugs for the following two programs:
- Mail Service Saver: Prescriptions are filled through OptumRx® home delivery pharmacy
- Saver90: Prescriptions are filled through select participating retail pharmacies or the OptumRx® home delivery pharmacy
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