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2017 Prescription Drug Coverage Guides


Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc. will follow two types of drug coverage starting in 2017.

Already a member? You should receive information from us in the mail in November 2016 about changes to your pharmacy coverage in 2017.

Shopping for a plan? If you are shopping for a plan, check our plan brochures for more about which plans follow this type of drug coverage.

2017 Covered Drug Lists   2017 Open Drug Lists

Do these lists apply to you?
The 2017 Covered Drug Lists are new for many members. Most members whose plans follow these lists, either…

  • bought or renewed a 2017 individual or family plan on HealthCare.gov or through an agent, OR
  • get health insurance at work from a small group employer (50 or fewer employees), that has made major changes to the coverage it offers since March 23, 2010 (also known as a non-grandfathered plan) OR
  • get insurance at work from a group that has chosen to follow these lists.

 

Do these lists apply to you?
Most members whose plans follow this list, either…

  • get health insurance at work from a large group (51 or more employees), OR
  • get health insurance at work from a small group employer (50 or fewer employees) that has not made major changes to the coverage it offers since March 23, 2010 (also known as a grandfathered plan),
  • have not made major changes to their individual or family coverage since March 23, 2010 (also known as a grandfathered plan), OR
  • get insurance at work from a group that has chosen to follow these lists.

 

There are exceptions to these cases. Read your printed benefit materials to find out the type of drug coverage your plan offers and if any rules apply.

Questions About Your Drug Coverage?

  • Log in to your online account,
  • Visit the Express Scripts, Inc.* website, or
  • Call Express Scripts* Customer Service at 1-866-781-7533 or the Pharmacy number on your ID card.


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.

*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.