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Refer to your printed benefit materials to find out if your prescription plan is three-tier or five-tier and if other limitations apply.

• Quantity Per Dispensing (QPD) Level Limits/Allowances [PDF] Updated 05/12/2008
  Most commonly prescribed medications subject to QPD limits/allowances (coverage varies by plan)
  
  
• Drugs Requiring Prior Authorization [PDF] Updated 03/03/2008
  Certain prescription drugs require prior authorization for benefit coverage. Check back for periodic updates. Physicians must call the Clinical Authorization Department at 1.800.376.7741 for authorization.
  
  
• Specialty Pharmacy Program Drug List [PDF]
  Check with your plan administrator to see if your coverage includes specialty retail drug supply limits or mandatory specialty
  

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.

Manage Your Drug Coverage Online

When you register with Express Scripts, Inc. (ESI), an independent company that serves as the pharmacy benefit manager for Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc., use only the numerals in your member ID number and omit the letters. Dependents over age 18 must register separately, but can permit adults under the same member number to view their account.

Registered users can access:

• Details on your prescription benefits, including co-pay/coinsurance costs
• Prescription drug history for you and your covered family members (some limits apply)
• Possible interactions of your prescription drugs with other medicines, food or alcohol
• A pharmacy locator that helps you find available 24-hour pharmacies closest to your home
• Mail-order prescription services, ordering and tracking 

Filing Claims

• Prescription Drug Claim Form [PDF] 

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