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2017 Prescription Drug Coverage Guides

This page will be updated by Nov. 1, 2016. Please check back for more information.

2016 Prescription Drug Coverage Guides

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.

2016 Drug Formularies:                           2-Tier   4-Tier

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.

2016 Drug Formularies:                           3-Tier   5-Tier

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.

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.

Step Therapy

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.

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.