2011 Drug Formulary

The RxBLUE PDP Formulary is a list of all drugs covered under your plan. The formulary consists of more than 1,400 medications. Additionally, we provide monthly formulary updates to keep information current.

View the RxBLUE PDP Formulary
The formulary is current as of October 2010. For changes since that date, view the latest formulary update below.

2011 Formulary Update
This document shows any medication changes made to the plan since October 2010.

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

Quantity Limit Requirements
These drugs have restrictions on fill amounts.

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.

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?

RxBLUE PDP covers both 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 the 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 formulary change?

Yes, drugs may be added or removed from our formulary during the year. The formulary is current as of October 2010 and is valid through Dec. 31, 2011.

Generally, if you are taking a drug on our 2011 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2011 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 our formulary, 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. The formulary is current as of September 2010.

To get updated information about the drugs covered by RxBLUE, please visit our Web site at www.bcbsla.com or call Customer Services 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 formulary is reviewed on a regular basis. Information on changes to the RxBLUE formulary throughout the year can be found on the RxBLUE Web site.

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 our formulary. 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 Evidence of Coverage (Chapter 7, pages 72-95). Read more information regarding exceptions, appeals and complaints by viewing the Your Rights page 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 restrictions or limits. 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.

Our Organization contracts with the Federal government. RxBLUE PDP is a stand-alone prescription drug plan with a Medicare contract.

S5937
CMS 101310 Approved
Page Last Updated: 10:00 am on 11.05.2010