Skip to main content
MyBlue®:

Prescription Drugs

See how your Service Benefit Plan coverage works with different types of prescription drugs.

Helping you understand your prescription costs

The formulary is a list of our covered prescription drugs, including generic, brand name and specialty drugs.

See how we help keep your out-of-pocket costs low for the medications you and your family need.

Formularies

2024 FEP Blue Focus® Formulary

2024 FEP Blue Basic™ Formulary

Traditional Drug List

MPDP Drug List

2024 FEP Blue Standard™ Formulary

Traditional Drug List

MPDP Drug List

New for 2024: FEP Medicare Prescription Drug Program (MPDP)

Eligible members with Medicare get lower out-of-pocket costs for higher cost drugs and additional approved prescription drugs in some tiers than the traditional pharmacy benefit.

Learn More

Drug tiers

We organize our covered prescription drugs into tiers. The amount you pay for a drug depends on the tier. In general, the lower the drug tier, the less you pay.

  • There are five drug tiers under the traditional pharmacy benefit for FEP Blue Basic™ and FEP Blue Standard™.
  • There are only two drug tiers under the traditional pharmacy benefit for FEP Blue Focus®.
  • There are four drug tiers under MPDP for all our plans.

Try our Prescription Drug Cost Tool

Our Prescription Drug Cost Tool lets you check drug costs 24/7. See if your drug is covered under your selected plan and compare costs of covered drugs for all three plans.

Check Drug Costs

Prescription drug benefits for 2024

 

See 2024 benefit updates and rates here.

FEP Blue Focus® FEP Blue Basic™ FEP Blue Standard™
Preferred Retail Pharmacy

Tier 1 (Generics): $5 copay up to a 30-day supply; $15 copay for a 31 to 90-day supply
Tier 2 (Preferred brand): 40% of our allowance ($350 max) for up to a 30-day supply; $1,050 maximum for 31 to 90-day supply)

 Tier 1 (Generics): $15 copay up to a 30-day supply; $40 copay for a 31 to 90-day supply 
Tier 2 (Preferred brand): $60 copay for up to a 30-day supply; $180 copay for a 31 to 90-day supply 
Tier 3 (Non-preferred brand): 60% of our allowance ($90 minimum) for up to a 30-day supply; $250 minimum for a 31 to 90-day supply)
Tier 4 (Preferred specialty): $85 copay
Tier 5 (Non-preferred specialty): $110 copay

Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program. 		Tier 1 (Generics): $7.50 copay for up to a 30-day supply; $22.50 copay for a 31 to 90-day supply
Tier 2 (Preferred brand): 30% of our allowance
Tier 3 (Non-preferred brand): 50% of our allowance
Tier 4 (Preferred specialty): 30% of our allowance
Tier 5 (Non-preferred specialty): 30% of our allowance

Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program.
 
Mail Service Pharmacy Not a benefit Available to members with Medicare Part B primary only. Visit the Medicare page for more information. Tier 1 (Generics): $15 copay
Tier 2 (Preferred brand): $90 copay
Tier 3 (Non-preferred brand): $125 copay

Covers a 22 to 90-day supply. Nothing for the first 4 prescription fills or refills when you switch from certain brand name drugs to specific generic drugs.
Specialty Pharmacy

Tier 2 (Preferred specialty): 40% of our allowance ($350 maximum) for a 30-day supply; $1,050 maximum for 31 to 90-day supply

 Tier 4 (Preferred specialty): $85 copay
Tier 5 (Non-preferred specialty): $110 copay

90-day supply may only be obtained after third fill. 		Tier 4 (Preferred specialty): $65 copay for up to a 30-day supply; $185 copay for a 31 to 90-day supply 
Tier 5 (Non-preferred specialty): $85 copay for up to a 30-day supply; $240 copay for a 31 to 90-day supply

90-day supply may only be obtained after third fill.
This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s Federal brochures (FEP Blue Standard and FEP Blue Basic: RI 71-005; FEP Blue Focus: 71-017). All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.

Prior approval and covered equivalents

Some prescription drugs and supplies need prior approval when using your pharmacy benefits

To give prior approval, we need to confirm two things: 1. that you’re using the drug to treat something we cover and 2. that your healthcare provider prescribes it in a medically appropriate way. 

Your healthcare provider can request prior approval electronically, by fax or by mail. The full list of drugs that need to be approved, prior approval forms and additional information can be downloaded here.

MPDP may require prior approval and has quantity limits for specific drugs

Specific drugs on the approved MPDP drug list require prior approval and/or have quantity limits. We have these policies for safety purposes. You can see drugs with prior approval criteria and step therapy criteria on the MPDP Drug List here. The full list of Prior approval MPDP Criteria and Step Therapy Criteria can be downloaded under MPDP Resources by Plan.

We also require prior approval for select high-cost drugs when using your medical benefits

Your health care provider can request prior approval by contacting your local BCBS company. The full list of these select high-cost drugs can be downloaded here. 

Covered equivalents for drugs not on our formulary

Our three plan options have certain drugs that are not covered on their formularies (approved drug lists). Each non-covered drug has safe and effective, alternative covered drug options. You can see the list of what’s not covered and available alternative options for FEP Blue Standard and FEP Blue Basic. FEP Blue Focus members can apply for coverage of a drug not covered on their formulary with the Non-Formulary Exception Process (NFE) form.

Get in Touch

Retail Pharmacy Program

1-800-624-5060

Mail Service Pharmacy

For refills, call: 1-877-FEP-FILL (1-877-337-3455)

1-800-262-7890

Specialty Drug Program

1-888-346-3731

FEP Medicare Prescription Drug Program

1-888-338-7737

We use cookies on this website to give you the best experience and measure website usage. By continuing to use this website, you consent to these cookies. For more information, view our privacy policy.