How Do I Know if My Plan Covers My Prescription Drug?

When your doctor prescribes a drug you've never taken before, you may wonder if your plan will help pay for it. Or maybe you need to know what tier a drug is in, or whether it's a preferred or nonpreferred brand. 

You have different options for getting this information. We'll help you understand where to look.

Log in to your member account

Use this option when you want to find out:

  • Whether your plan covers or helps pay for a prescription
  • The price of a prescription
  • If it has any requirements or limits

You can log in on our website or use the Blue Cross mobile app. You'll need the name of the drug and the prescribed dosage.

After you log in, look for the prescription section under My Coverage, then:

  • On our website, select Price a Drug
  • On the app, go to pharmacy coverage, and select Price a Medication from the main screen; you may have to scroll down a little

How to get information about your plan's tiers

Tiers are used to define what your copay or coinsurance will be for a drug. It's best to get this information in your member account on our website. Go to My Coverage, then:

  • PPO members, look under What's Covered
  • HMO members, look for your prescription drug rider under Plan Documents

You'll find out how many tiers your plan has and what you pay for each tier.

Look on a drug list

Drugs approved by the U.S. Food and Drug Administration and covered by your insurance are listed in your plan's drug list, or formulary.

Each plan has a main drug list. Use it to find out:

  • Whether your plan covers or helps pay for a prescription
  • What tier a drug is in, and if it's considered preferred or nonpreferred
  • If it has any requirements or limits

You'll need to know the name of your plan and the name of the drug. It'll be easier to find a drug if you know what it's used for.

Most plans also have specialized drug lists just for:

  • Drugs that need prior authorization and step therapy
  • Specialty drugs
  • Drugs that have a 15-day quantity limit

These drugs are included on your plan's main drug list. But you'll get more information about them in the specialized lists.

Find your drug lists

If your prescription drug isn't covered

If the drug is on the medical part of your benefit, talk to your doctor about getting preapproval for it.

If you have a PPO or HMO plan, and the requested drug is not on your approved drug list and you need your request taken care of right away, fill out our expedited request form.

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