Prescription Drug Coverage Guide


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: After opening a formulary, hold the Ctrl key while pressing "F" on your keyboard.

2010 Drug Formularies: View 3-Tier  View 5-Tier

 

 

 

Specific Drug Coverage Requirements

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.

Need to File a Prescription Claim?

Prescription Drug Claim Form
Use this form if you need to manually file a prescription drug claim.

Questions about Your Drug Coverage?

*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, Inc.

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.