2012 Drug Formularies

The RxBLUE Basic PDP Formulary and RxBLUE Plus PDP Formulary are lists of all drugs covered under your plan. The RxBLUE Basic PDP Forumlary consists of more than 1,900 drugs. The RxBLUE Plus PDP formulary consists of more than 3,000 medications. Additionally, we provide monthly formulary updates for RxBLUE Basic PDP and RxBLUE Plus PDP to keep information current.

RxBLUE Basic PDP

View the Formulary

2012 RxBLUE Basic PDP Formulary Update
This document shows any medication changes made to the plan since November 2012.

RxBLUE Basic PDP Prior Authorization Criteria
This is a list of drugs that require prior approval before they can be filled.

RxBLUE Basic PDP Quantity Limit Requirements
These drugs have restrictions on fill amounts.

RxBLUE Basic PDP Step Therapy Criteria
These drugs require the use of an alternative (typically generic) medication first.

Transition Policy Statement
If you would like to view our transition policy, click here.

RxBLUE Plus PDP

View the Formulary

2012 RxBLUE Plus PDP Formulary Update
This document shows any medication changes made to the plan since November 2012.

Transition Policy Statement
If you would like to view our transition policy, click here.

RxBLUE Plus PDP Prior Authorization Criteria
This is a list of drugs that require prior approval before they can be filled.

RxBLUE Plus PDP Quantity Limit Requirements
These drugs have restrictions on fill amounts.

RxBLUE Plus PDP Step Therapy Criteria
These drugs require the use of an alternative (typically generic) medication first.

Once you have opened one of these formulary documents, you can search for a specific drug or word by holding the Ctrl key while pressing F on your keyboard.

Why choose generics?

Both plans cover brand-name drugs and generic drugs. Generic drugs have the same active ingredient as a brand-name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.

You will notice that each formulary offers generic substitutions for brand-name drugs when possible. By choosing generics, you will still get effective, safe treatment, and you may save money.

Can the RxBLUE (PDP) formularies change?

Yes, drugs may be added or removed from our formularies during the year.

Generally, if you are taking a drug on one of our 2012 formularies that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2012 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.

If we remove drugs from one of our formularies, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

To get updated information about the drugs covered by RxBLUE PDP, please see the links above or call Customer Service at 1-888-223-BLUE (2583), 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-947-5277. The RxBLUE formularies are reviewed on a regular basis. Information on changes to the RxBLUE formularies throughout the year can be found on this page.

Can I receive coverage for drugs not on the formulary?

Yes, if you believe you are entitled to payment or benefits on a certain drug, you can request a coverage determination. A coverage determination is a decision made by RxBLUE (PDP) regarding payment for a Part D drug or exceptions to one of our formularies. If your coverage determination is denied, you can appeal the decision by asking for a redetermination of the original request. Full details on coverage determinations, exceptions and appeals can be found in the RxBLUE Basic PDP Evidence of Coverage (Chapter 7, pages 82-104) or the RxBLUE Plus PDP Evidence of Coverage (Chapter 7, pages 82-105). Read more information regarding exceptions, appeals and complaints by viewing the Your Rights page under the 2012 RxBLUE PDP section of this website.

Learn more about submitting Coverage Determinations, Appeals or Complaints

What if I'm already taking a drug RxBLUE (PDP) doesn't cover?

During the first 90 days of enrollment, we extend up to a one-month transition supply of medication (unless the prescription is written for fewer days) to members for drugs that are not on our formulary as well as drugs with step therapy or prior authorization restrictions. Call Customer Service to find out more.

Filing Claims

RxBLUE (PDP) offers automatic claims filing on your behalf. Should you need to file a claim yourself, please use the prescription drug claim form.

Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company, a Medicare-approved Part D sponsor.

S5937_MKT110411
CMS Approved 12132011
Page Last Updated: 11:00 a.m. on 12.05.2012