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Essential Formulary

The Essential Formulary Guide will help you understand and use your pharmacy benefits. It contains a list of medications your plan covers – and how much you might owe out of pocket. Pharmacy benefit plans that use the Essential Formulary focus on the safe and effective use of generic drugs. These plans do cover selected brand-name drugs for certain drug classes, but cover only generics for several classes. All covered prescription drugs fall into tiers, which represent the level of cost that you will pay for that particular drug. There are two Essential Formularies.

Essential Formulary Guide

The Essential Formulary Guide applies only to the following Individual and Small Group plans:

  • BlueCross Bronze 07
  • BlueCross Bronze 08
  • BlueCross Gold 06
  • BlueCross SG Bronze 15
  • BlueCross SG Bronze 18
  • BlueCross SG Bronze 22
  • BlueCross SG Bronze 23
  • BlueCross SG Bronze 24
  • BlueCross SG Bronze 25
  • BlueCross SG Silver 40
  • BlueCross SG Silver 43
  • BlueCross SG Silver 50
  • BlueCross SG Silver 57
  • BlueCross SG Silver 59
  • BlueCross SG Silver 60
  • BlueCross SG Silver 61
  • BlueCross SG Silver 62
  • BlueCross SG Silver 63
  • BlueCross SG Silver 64
  • BlueCross SG Silver 65
  • BlueCross SG Silver 66
  • BlueCross SG Silver 67
  • BlueCross SG Silver 68
  • BlueCross SG Silver 71
  • BlueCross SG Gold 48
  • BlueCross SG Gold 49
  • BlueCross SG Gold 50
  • BlueCross SG Gold 51
  • BlueCross SG Gold 52
  • BlueCross SG Gold 53
  • BlueCross SG Gold 54
  • BlueCross SG Gold 55
  • BlueCross SG Gold 57
  • BlueCross SG Platinum 15
  • BlueCross SG Platinum 16
  • BlueCross SG Platinum 17
  • BlueCross SG Platinum 18
  • BlueCross SG Platinum 19

2019 Essential Formulary Guide

What's Changing on the Essential Formulary Guide (5 Tier) for 2019?

What's a Drug Tier?
The formulary includes five tiers of medications. The copay, deductible or coinsurance for your prescription is based on which tier your drug falls into.

  • Tier 1 – Generic Drugs
  • Tier 2 – Preferred Brand Drugs
  • Tier 3 – Non-Preferred Brand Drugs
  • Tier 4 – Specialty Drugs
  • Tier 5 – Drugs with $0 Cost Share

Essential Formulary Guide with Preventive Copays

The Essential Formulary Guide with Preventive Drug Copays applies only to the following Individual and Small Group plans:

  • BlueCross Silver 01
  • BlueCross Silver 04
  • BlueCross Silver 20
  • BlueCross SG Bronze 19
  • BlueCross SG Bronze 20
  • BlueCross SG Bronze 26
  • BlueCross SG Silver 25
  • BlueCross SG Silver 41
  • BlueCross SG Silver 52
  • BlueCross SG Silver 69
  • BlueCross SG Silver 70
  • BlueCross SG Gold 24
  • BlueCross SG Gold 25
  • BlueCross SG Gold 26
  • BlueCross SG Gold 56

2019 Essential Formulary Guide with Preventive Copays

What's Changing on the Essential Formulary Guide (6 Tier) for 2019?

What's a Drug Tier
This formulary includes six tiers of medications. The copay, deductible or coinsurance for your prescription is based on which tier your drug falls into.

  • Tier 1 – Generic Drugs with copay-based on the BlueCross Preventive Drug List
  • Tier 2 – Preferred Brand Drugs with copay-based on BlueCross Preventive Drug List
  • Tier 3 – Non-Preferred Brand Drugs with copay-base on BlueCross Preventive Drug List
  • Tier 4 – Specialty Drugs with Deductible/Coinsurance
  • Tier 5 – Drugs with $0 Cost Share per Affordable Care Act (ACA) $0 Copay Preventive List
  • Tier 6 – Generic or Brand Non-Specialty Drugs with Deductible/Coinsurance
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In Tennessee, 55% of those using prescription pain pills inappropriately get them from family and friends. Prevent abuse and misuse by counting, securing and disposing of medications properly.

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