Pharmacy and drug tools

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Drug formularies and drug listings are reviewed on an ongoing basis and subject to change.

Drug Formularies

Brand name and generic prescription drugs reimbursed at maximum payment levels by BCBSND

2022 BCBSND Formulary - updated January 2022
Latest Additions and Deletions - updated January 2022
2022 BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary - updated January 2022
2021 BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary - updated January 2022
2022 NetResults Formulary - updated January 2022

Nonpayable Drugs

Prescription drugs not covered by BCBSND

Nonpayable Drug List - updated September 1, 2021

Restricted-Use Drugs

Drugs that have a dispensing limit and/or require prior approval

Restricted-Use Prior Approval Drugs - updated January 2022
Restricted-Use Opioids - updated January 2022
Restricted-Use Step Therapy Drugs - updated January 2022
Restricted-Use Insulin - updated January 2022
Restricted-Use Drug Dispensing Limits (BCBSND Formulary) - updated January 2022
Restricted-Use Drug Dispensing Limits (BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary) - updated January 2022

Specialty Drugs

Medications or drugs that are generally high in cost and/or require special administration, limited availability, unique delivery and dispensing, or patient support or monitoring

Specialty Drug List - updated January 2022

Value Based Design (VBD) Drug List

2021 BlueCare, BluePartner nonHDHP, BluePrime, SimplyBlue Value Based Design (VBD) Drug
2022 Value Based Design (VBD) Drug List - updated January 2022
2022 BlueCare, BluePartner nonHDHP, BluePrime, SimplyBlue Value Based Design (VBD) Drug - updated January 2022

HSA Preventive Drugs

Drugs covered under an HSA preventive drug benefit
The HSA Preventive Drug benefit is not included with all benefit plans. Please review your benefit plan materials to determine coverage. Contact customer service using the number on the back of your Insurance ID card with any questions.

2022 HSA Preventive Drug - updated January 2022
2021 BlueDirect, BluePartner HDHP Preventive Drug
2022 BlueDirect, BluePartner HDHP Preventive Drug - updated January 2022

Over-the-Counter Medications

Non-prescription drugs covered by BCBSND when dispensed by a pharmacist upon receipt of a prescription order.

Over-the-Counter Medications List - updated November 2019

Excluded Route of Administration

A prescription medication or drug with an excluded pharmacy benefit route of administration will reject at pharmacy point of sale and may be covered under the medical benefit.

Routes of Administration Pharmacy Benefit Exclusion List - updated January 2022
Routes of Administration Self-Administered Drug List - updated January 2022

NetResults

Information specific to NetResults 

2022 NetResults Formulary - updated January 2022
2022 NetResults HSA Preventive Drug List - updated January 2022
2022 NetResults Value Based Design Drug List - updated January 2022
NetResults Restricted Use List - Opioids - updated January 2022
NetResults Quantity Limit Program Summary - updated January 2022

Where To Find Prescription Drug Information

Get information on your prescription drug coverage and usage:

• Log in to your Member Portal account and select Prescriptions
• Call Prime Therapeutics at 855-457-0007