A drug list or formulary is a list of generic and brand-name prescription drugs covered by your health plan. Although a drug may be on the Blue Cross drug list, it might not be covered under your plan. Review your certificate of coverage or other plan materials for details on your prescription drug benefits.

Drugs are carefully selected

An independent group of practicing pharmacists and physicians, the Pharmacy and Therapeutics Committee, reviews all available drugs on an ongoing basis and then selects those that are considered “best choices.” They review scientific literature and reports, consult with other health care professionals and use their own expertise to make their decisions.

Before a drug is included in the drug list, it must pass a strict review by the committee, based on these criteria:

• Safety: it must be approved by the U.S. Food and Drug Administration (FDA).
• Efficacy: it must be effective in treating a disease or symptoms with few side effects.
• Uniqueness: the new drug must offer unique qualities compared to existing drugs in the drug list.
• Cost: the new drug must demonstrate a positive impact on total health care costs.

Lower-cost drugs are preferred

Often, there are many drugs available to treat the same condition. In some cases, two drugs are equivalent in effectiveness and safety. In this case, the preferred drug included on the drug list will be the lower-cost drug. Blue Cross negotiates discounts on behalf of our members. We pass these savings on to you by holding down prescription drug coverage costs.

Remember, not all benefit plans are subject to the prescription drug list. Check your certificate or other plan information for benefit details.