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MyBlue®:

Prescription Drugs

See how your Service Benefit Plan coverage works with different types of prescription drugs.

Helping you understand your prescription costs

The formulary is a list of our covered prescription drugs, including generic, brand name and specialty drugs.

See how we help keep your out-of-pocket costs low for the medications you and your family need.

Formularies

2022 FEP Blue Focus Formulary

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2022 Basic Option Formulary

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2022 Standard Option Formulary

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Drug tiers

We organize our covered prescription drugs into tiers. The amount you pay for a drug depends on the tier. In general, the lower the drug tier the more cost effective the drug. Basic Option and Standard Option each have five drug tiers. FEP Blue Focus has only two drug tiers. 

FEP Blue Focus

Tier 1:
Preferred Generic Drugs

Typically the most affordable drug type, and are equal to their brand name counterparts in quality, performance characteristics and intended use.

Tier 2:
Preferred Brand Name Drugs
Preferred Generic Specialty Drugs
Preferred Brand Name Specialty Drugs

Preferred brand name: Proven to be safe, effective, and favorably priced compared to Non-preferred brands.

Specialty: Used to treat complex health conditions. Proven to be safe, effective, and favorably priced compared to Non-preferred specialty drugs.

Standard & Basic Option

Tier 1:
Generic Drugs


Typically the most affordable drug type, and are equal to their brand name counterparts in quality, performance characteristics and intended use.

Tier 2:
Preferred Brand Name Drugs

Proven to be safe, effective, and favorably priced compared to Non-preferred brands. Cheaper than Non-preferred brands but more expensive than generics.

Tier 3:
Non-preferred Brand Name Drugs

Proven to be safe and effective. Typically have a higher cost because these drugs have either a generic or Preferred brand available.

Tier 4:
Preferred Specialty Drugs

Used to treat complex health conditions. Proven to be safe, effective, and favorably priced compared to Non-preferred specialty drugs.

Tier 5:
Non-preferred Specialty Drugs

Typically have a higher cost because these drugs have a Preferred specialty available.

Try our Prescription Drug Cost Tool

Our Prescription Drug Cost Tool lets you check drug costs 24/7. See if your drug is covered under your selected plan and compare costs of covered drugs for all three plans.

Check Drug Costs

Prescription drug benefits for 2023

See 2023 benefit updates and rates here.

FEP Blue Focus Basic Option Standard Option
Preferred Retail Pharmacy Tier 1 (Generics): $5 copay; $15 copay for a 31 to 90-day supply
Tier 2 (Preferred brand): 40% of our allowance ($350 max) for up to a 30-day supply; $1,050 maximum for 31 to 90-day supply
Tier 1 (Generics): $15 copay up to a 30-day supply; $40 copay for a 31 to 90-day supply
Tier 2 (Preferred brand): $60 copay for up to a 30-day supply; $180 copay for a 31 to 90-day supply
Tier 3 (Non-preferred brand): 60% of our allowance ($90 minimum) for up to a 30-day supply; $250 minimum for a 31 to 90-day supply
Tier 4 (Preferred specialty): $85 copay
Tier 5 (Non-preferred specialty): $110 copay

Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program.

Tier 1 (Generics): $7.50 copay for up to a 30-day supply; $22.50 copay for a 31 to 90-day supply
Tier 2 (Preferred brand): 30% of our allowance
Tier 3 (Non-preferred brand): 50% of our allowance
Tier 4 (Preferred specialty): 30% of our allowance
Tier 5 (Non-preferred specialty): 30% of our allowance

Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program.

 

 

Mail Service Pharmacy

Not a benefit   

Available to members with Medicare Part B primary only. Visit the Medicare page for more information. Tier 1 (Generics): $15 copay 
Tier 2 (Preferred brand): $90 copay 
Tier 3 (Non-preferred brand): $125 copay

 

Covers a 22 to 90-day supply. Nothing for the first 4 prescription fills or refills when you switch from certain brand name drugs to specific generic drugs.

Specialty Pharmacy

Tier 2 (Preferred generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum)

Specialty drugs are limited to a 30-day supply.

Tier 4 (Preferred specialty): $85 copay for up to a 30-day supply; $235 copay for a 31 to 90-day supply
Tier 5 (Non-preferred specialty): $110 copay for up to a 30-day supply; $300 copay for a 31 to 90-day supply

 

90-day supply may only be obtained after third fill.

Tier 4 (Preferred specialty): $65 copay for up to a 30-day supply; $185 copay for a 31 to 90-day supply 
Tier 5 (Non-preferred specialty): $85 copay for up to a 30-day supply; $240 copay for a 31 to 90-day supply


90-day supply may only be obtained after third fill.

 

 

This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s Federal brochures (Standard Option and Basic Option: RI 71-005; FEP Blue Focus: 71-017). All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.

Prescription drug benefits for 2022

FEP Blue Focus Basic Option Standard Option
Preferred Retail Pharmacy

Tier 1 (Generics): $5 copay; $15 copay for a 31 to 90-day supply

Tier 2 (Preferred brand): 40% of our allowance ($350 max) for up to a 30-day supply; $1,050 maximum for 31 to 90-day supply



Tier 1 (Generics): $10 copay up to a 30-day supply; $30 copay for a 31 to 90-day supply
Tier 2 (Preferred brand): $55 copay for up to a 30-day supply; $165 copay for a 31 to 90-day supply
Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum) for up to a 30-day supply; $210 minimum for a 31 to 90-day supply
Tier 4 (Preferred specialty): $85 copay
Tier 5 (Non-preferred specialty): $110 copay

Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program.

Tier 1 (Generics): $7.50 copay for up to a 30-day supply; $22.50 copay for a 31 to 90-day supply

Tier 2 (Preferred brand): 30% of our allowance

Tier 3 (Non-preferred brand): 50% of our allowance

Tier 4 (Preferred specialty): 30% of our allowance

Tier 5 (Non-preferred specialty): 30% of our allowance


Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program.



Mail Service Pharmacy

Not a benefit

Available to members with Medicare Part B primary only. Visit the Medicare page for more information.

Tier 1 (Generics): $15 copay 
Tier 2 (Preferred brand): $90 copay 
Tier 3 (Non-preferred brand): $125 copay

 

Covers a 22 to 90-day supply. Nothing for the first 4 prescription fills or refills when you switch from certain brand name drugs to specific generic drugs. 

Specialty Pharmacy

Tier 2 (Preferred generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum)

Specialty drugs are limited to a 30-day supply.


Tier 4 (Preferred specialty): $85 copay for up to a 30-day supply; $235 copay for a 31 to 90-day supply
Tier 5 (Non-preferred specialty): $110 copay for up to a 30-day supply; $300 copay for a 31 to 90-day supply

 

90-day supply may only be obtained after third fill.

Tier 4 (Preferred specialty): $65 copay for up to a 30-day supply; $185 copay for a 31 to 90-day supply 
Tier 5 (Non-preferred specialty): $85 
copay for up to a 30-day supply; $240 copay for a 31 to 90-day supply

 

90-day supply may only be obtained after third fill.


This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s federal brochures (RI 71-005 and RI 71-017). All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.

Some prescription drugs and supplies need prior approval when using your pharmacy benefits

To give prior approval, we need to confirm two things: that you’re using the drug to treat something we cover and that your health care provider prescribes it in a medically appropriate way. Your health care provider can request prior approval electronically, by fax or by mail. The full list of drugs that need to be approved, prior approval forms and additional information can be downloaded here.

In 2023 we will also require prior approval for select high-cost drugs when using your medical benefits

Your health care provider can request prior approval by contacting your local BCBS company. The full list of these select high-cost drugs can be downloaded here.

Covered equivalents for drugs not on our formulary

Our three plan options have certain drugs that are not covered on their formularies. Each non-covered drug has safe and effective, alternative covered drug options. You can see the list of what’s not covered and available alternative options for Standard Option and Basic OptionFEP Blue Focus members can apply for coverage of a drug not covered on their formulary with the Non-Formulary Exception Process (NFE) form.

Get in Touch

Retail Pharmacy Program

Mail Service Pharmacy

For refills, call: 1-877-FEP-FILL (1-877-337-3455)

Specialty Drug Program

24/7 Nurse Line

Get prescription advice from a registered nurse