Drug Lists for Group Members

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

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 Authorization and Step Therapy Guidelines (PDF)
A list of drugs that need to be approved before your plan will cover them.

Preferred Drug List Exclusions (PDF)
A list of drugs that aren't covered on the Preferred Drug List. Use this list to find alternatives for drugs that aren’t covered. 

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 Drug List (PDF)
The list of drugs covered by your plan if your plan uses the Custom Drug List. This drug list is updated monthly.

Custom and Clinical Drug List Exclusions (PDF)
A list of drugs that aren't covered on the Custom and Clinical Drug Lists. Use this list to find alternatives for drugs that aren’t covered. 

Preferred Alternatives (PDF)
If your plan uses the Custom Drug List and a drug you've been prescribed is a non-preferred drug, your doctor can use this list to find an alternative.

Custom Select drug lists

Custom Select Drug List (PDF)
The list of drugs covered by your plan if your plan uses the Custom Select Drug List. This drug list is updated monthly.

Custom Select Drug List Exclusions (PDF)
A list of drugs that aren't covered on the Custom Select Drug List. Use this list to find alternatives for drugs that aren’t covered. 

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.

Other helpful resources

Preventive Drug List for Members with Health Savings Accounts-Including Diabetic Drugs (PDF)
A list of preventive drugs that help you lose weight, lower your cholesterol, lower your blood pressure, manage your blood sugar and other drugs that address other common conditions.

Preventive Drug Coverage (PDF)
A list of preventive drugs that are covered with $0 copay. For information specific to your preventive benefits, please check your Blue Cross benefits-at-a-glance or BCN drug rider. 

Preventive Drug List for Members with Health Savings Accounts (PDF)
A list of preventive drugs that help you lose weight, lower your cholesterol, lower your blood pressure and other drugs that address other common conditions. 

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.

Exclusive Smart90SM Maintenance Drug List (PDF)
A list of prescription drugs that you get at a participating Smart90 retail pharmacy or through Express Scripts mail-order in order for them to be covered by your plan, after your first two fills of the prescription.