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 if your prescription plan is three-tier or five-tier and if other limitations apply.
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2009 Drug Formulary: |
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Pharmacy Services
Keeping our prescription drug lists current is just one service the Blue Cross pharmacy staff provides. We also provide tools to help manage your pharmacy needs and save you money in the long run.
Drug Coverage Resources
- Quantity Per Dispensing (QPD) Level Limits/Allowances [PDF] Updated 06/12/2009
Most commonly prescribed medications subject to QPD limits/allowances (coverage varies by plan)
- Drugs Requiring Prior Authorization [PDF] Updated 06/12/2009
Certain prescription drugs require prior authorization for benefit coverage. Check back for periodic updates. Prior authorization requests are processed by our pharmacy benefit manager, Express Scripts, Inc. (ESI). Physicians must call ESI to obtain an authorization. (1-800-842-2015).
- Specialty Pharmacy Program Drug List [PDF] Updated 06/12/2009
Check with your plan administrator to see if your coverage includes specialty retail drug supply limits or mandatory specialty
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.
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