View drugs covered under your plan by selecting one of the documents below.
Refer to your printed benefit materials to find out the type of prescription plan your coverage offers and if other limitations apply.
Search tip: Drugs are listed in the index in alphabetical order or you can hold the Ctrl or Command key while pressing F on your keyboard to search for your drug.
The 2-tier and 4-tier drug formularies apply to non-grandfathered individual policyholders and group members for new sales and renewals on or after Jan. 1, 2014.
The 3-tier and 5-tier formularies apply to grandfathered individual policyholders and group members and some non-grandfathered large group members effective prior to Jan. 1, 2014.
NOTICE: Inclusion of a drug in a drug formulary does not
guarantee that a member's physician or other authorized prescriber will
prescribe the drug for a particular medical condition or mental illness.
Some drugs have special restrictions for coverage. This can
include limits on each fill, pharmacy restrictions or
physician authorizations. Lists of these restrictions are below.
Use this form if you need to manually file a prescription drug
Our prescription step therapy program promotes the use of generic drugs as the first step in treating your
condition. How does the program work?
When you get a new prescription in certain drug classes, you must try a
generic option or similar alternative medication.
If the generic option is not right for you, your physician may
request an authorization for a brand-name drug.
If you do not follow the program, the brand-name drug will not
be covered under your benefits.
For more information on this program, view our Lead
with Generics brochure.
*Express Scripts, Inc.
(ESI) is an independent company that serves as the pharmacy benefit
manager for Blue Cross and Blue Shield of Louisiana and HMO Louisiana,
Not all options apply
to all benefit plans. Benefits and/or drug lists may have changed since
this information was posted. Please call the customer service number on
the back of your ID card for more information.
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