Check Drug Lists

A formulary (also known as a drug list) is a list of brand-name and generic drugs (or medications) that are covered under your prescription drug benefit. If you have a question about coverage, pricing, or rules, contact Customer Care using the number on the back of your member card.

Formularies

Medicare / Dual Special Needs Plans (D-SNP)

Visit our Medicare member’s Check Drug Lists to view your plan’s formulary.

Small Group / Individuals and Families

Applies to small groups (plans offered by employers with 100 employees or less), individuals and families who purchase their health plan on their own from NY State of Health (including the Essential Plan) or directly from Excellus BCBS.

Midsize / Large Group

Applies to midsize and large groups (plans offered by employers with more than 100 employees)

Medicaid Managed Care / HARP

Applies to those with Blue Choice Option, HMOBlue Option, or Blue Option Plus

Beginning April 1, 2023, all Medicaid members enrolled in Blue Choice Option, HMO Blue Option, and Blue Option Plus will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.

Learn more about the transition of the pharmacy benefit from Blue Choice Option, HMO Blue Option, and Blue Option Plus to NYRx, the Medicaid Pharmacy Program.

Access general information about NYRx, the Medicaid Pharmacy Program, along with additional information for Members and Providers.

Child Health Plus

Applies to those with Child Health Plus through Excellus BCBS.

Other Offerings and Programs

Specialty Drug List

Applies to commercial groups (plans offered by employers), individuals and families who purchase their health plan on their own from NY State of Health (including the Essential Plan) or directly from Excellus BCBS, and Child Health Plus through Excellus BCBS.

The following specialty drugs must be purchased from one of our participating specialty pharmacies in order to receive coverage under your prescription drug benefit (for medications that are self-administered).

Mandatory Maintenance Medication List

Some benefit plans require certain medications to be purchased through Express Scripts, Wegmans Home Delivery, or a mail order home delivery pharmacy.

Specific Employer Groups

Prior Authorization and Step Therapy Lists

Group Plans (Small, Midsize, and Large)

Applies to groups (plans offered by employers)

Child Health Plus

Applies to those with Child Health Plus through Excellus BCBS

Exception Review Requests

Some drugs require an exception review before they will be covered. To request an exception review for a drug that requires prior authorization, step therapy, or has a quantity limit, you may: