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Drug Formularies

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

2021 BCBSND Formulary - updated October 1, 2021
Latest Additions and Deletions - updated October 1, 2021
2020 BlueCare, BlueDirect, BlueEssential, BluePartner and SimplyBlue Formulary - updated October 1, 2021
2021 BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary - updated October 1, 2021

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 October 1, 2021
Restricted-Use Opioids - updated October 1, 2021
Restricted-Use Step Therapy Drugs - updated June 2021
Restricted-Use Insulin - updated August 2020
Restricted-Use Drug Dispensing Limits (BCBSND Formulary) - updated October 1, 2021
Restricted-Use Drug Dispensing Limits (BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary) - updated October 1, 2021

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 October 1, 2021

Value Based Design (VBD) Drug List

2021 BlueCare, BluePartner nonHDHP, BluePrime, SimplyBlue Value Based Design (VBD) Drug
2022 BlueCare, BluePartner nonHDHP, BluePrime, SimplyBlue Value Based Design (VBD) Drug

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.

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

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 October 1, 2021

NetResults

Information specific to NetResults 

2021 NetResults Formulary - updated October 1, 2021
2021 NetResults HSA Preventive Drug List - updated November 2020
NetResults Value Based Design Drug List - updated November 2020
NetResults Restricted Use List - Opioids - updated October 1, 2021
NetResults Quantity Limit Program Summary - updated October 1, 2021

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