INDIVIDUAL & EMPLOYER PHARMACY

All about your prescription coverage

When you log in to your account, you can see your personalized pharmacy benefits, price a drug and see the medications that are covered by your plan.

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See if your medication is covered

Here’s a breakdown of the medication lists, tiers and details covered by your plan. You can check your Member ID card to see which coverage you have.

Specialty Pharmacy experience you can trust

If your doctor prescribes a specialty drug for your condition, our experienced pharmacies can help.

MORE ABOUT OUR SPECIALTY MEDICATION PROGRAM
What is a specialty pharmacy or drug?

A specialty drug is a prescription drug that is given by injection or infusion, sometimes by you and sometimes in the doctor’s office. You’ll often get the best price for your medicine by getting it from certain specialty pharmacies, even if it’s your doctor or preferred facility doing the procedure. Learn more.

How do I know if mine is covered?

Check to see if your drug is one that you’ll give yourself (Preferred Medication List) or if it’s one your doctor gives in their office (Preferred Specialty Pharmacy medication list). There’s a list for each. If your drug isn’t covered, ask your doctor if there’s another similar one that might work. If not, ask them to request that we cover it for you, specifically. We call this an “exception.”

Where do I get them?

We’ve put together a list of specialty pharmacies that are trained to handle these types of drugs and can give them at the most affordable cost possible. If you want us to help you pay for your drug, you’ll need to use one of them.

Typically, once your doctor prescribes your drug, they’ll order it for you, and you’ll get a call from the specialty pharmacy when it’s ready to be filled.

Your doctor or specialty pharmacy will work with you directly to make sure you get what you need, check for any help with paying for your drugs, and even work out a payment plan, if you need it. You’ll pay the pharmacy directly, before you get the treatment.

How can I get help with the cost?

Ask your specialty pharmacist if there are any financial help programs available for your drug. Sometimes the manufacturer offers help with the cost. You can also ask your pharmacy for help making a payment plan.

Birth control coverage for women

If you’re not ready to grow your family, you have a lot of options. Talk to your doctor to help you choose what’s right for you.

MORE ABOUT BIRTH CONTROL COVERAGE
What if I need a medication that is not covered?

If you’re looking for a medication that isn’t covered, we can work with you. To get started, you or your doctor will need to fill out a Pharmaceutical Exception Request form. You’ll need your Member ID number and you might also have to send us some documents, so we know why other options didn’t work. You can either fax your request to us at (888) 343-4232(888) 343-4232 or send us an email at Fax_Pharmacy_Management@bcbst.com.

UNDERSTANDING INDIVIDUAL & EMPLOYER PHARMACY COVERAGE
Let’s help you find

Whether you want to understand your individual or employer pharmacy benefits or see what drugs are covered, we have a selection of forms that might be useful to you.

Is my drug covered?

You can check out all our drug lists here.

How do I get one of my drugs covered?

First, talk with your doctor about any generic versions or other drugs on your drug list that might work just as well. If we don’t cover a drug you need, your doctor can send us a request to cover it if they feel it’s important to your treatment. We’ll consider the request and get back to you on our decision.

How do I find a pharmacy in my network?

You can search for pharmacies by network in the Find a Doctor tool. Either search by the pharmacy's name and check which networks they're in, or search for ones near you and filter your results by your network. If you log in to BlueAccess first, your search results will automatically list pharmacies in your network. Need more help? Click here to contact us.

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As a member, you can get special coupons to save on medications and more at your pharmacy.

Featured offer: Get a free glucose monitor. Just click to download and print. Then, redeem your offer at a participating pharmacy near you.