The Blue Cross of Idaho formularies list drugs approved for coverage under your policy. The formularies include brand name as well as generic drugs that have undergone rigorous testing and are approved by the Food and Drug Administration (FDA). The formularies also provide information regarding the following:
Most employer groups use one of three formularies. You can verify which formulary to use by checking the Prescription Drug Program section of your plan's Benefit Description, located under Benefits & Coverage after logging in.
Qualified Health Plan Formulary - 6 Tier for Metal Level Plans - For individual and small group Affordable Care Act plans that are available through the healthcare exchange at Your Health Idaho or directly through Blue Cross of Idaho.
If you are unsure about the formulary your plan uses, please contact CVS Caremark RX Customer Care at the number on the back of your Blue Cross of Idaho member ID card to check costs for prescription drugs.
In most cases, you are responsible to pay a portion of the cost of each prescription you have filled. Drugs are categorized into benefit levels, also known as tiers, which determine the amount you pay. Costs are lowest for first tier (generic) drugs, and costs increase as the tiers increase. In addition to the tiers, certain preventive drugs may be covered at no cost.
To obtain a cost estimate for prescribed medications, based on your current benefits and accumulations, complete the following steps:
For questions regarding cost estimates obtained through the CVS website, or to obtain a cost estimate for your prescriptions over the phone, please contact CVS Caremark Rx Customer Care.
If you would like to know more about Specialty medications, please visit the Specialty Drugs page.
Generic drugs are equivalent to brand-name drugs in dosage, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically the same as their branded counterparts, they are typically sold at substantial discounts from the branded price. The use of generic medications is a valuable way to reduce overall prescription drug costs without sacrificing quality.
You have the option to choose a brand-name medication when a generic equivalent exists. However, when a brand-name medication is chosen over an available generic equivalent, you will pay the cost difference between the brand-name and generic medications, in addition to the brand-name copayments.
Some medications may have limits on how many doses are paid for by your policy. Limits are established with the manufacturers and the U.S. Food and Drug Administration’s (FDA) recommendations and accepted medical practices.
Quantity Limits for Qualified Health Plans are included in the formulary.
For all other plans, please review the Drugs with Quantity Limits or Restrictions List.
If your doctor or pharmacy told you a medication you were prescribed has a quantity limit and you have additional questions, please contact CVS Caremark RX Customer Care.