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Pharmacy and drug tools

Get the most current information on drugs covered in your BCBSND health insurance plan.

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Select from the dropdown below for benefits that are appropriate for you.

Please review your benefit plan materials to determine your Formulary. If you are unsure, please contact customer service using the number on the back of your Insurance ID card with any questions.

BCBSND Formulary
NetResults Formulary
BCBSND Health Insurance Market Individual Small Group Formulary
BCBSND BlueValue Formulary

BCBSND Formulary

The following lists are used by large employer group plans. (51 or more employees)

Drug Formulary List

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

2022 BCBSND Formulary - updated October 2022
Latest Additions and Deletions - updated October 2022

Restricted-Use Drugs

Drugs that are subject to a dispensing limit and/or require Prior Approval or Step Therapy

Restricted-Use Prior Approval Drugs - updated December 2022
Restricted-Use Drug Dispensing Limits - updated October 2022
Restricted-Use Step Therapy Drugs* - updated November 2022
Restricted-Use Opioids - updated December 2022
Restricted-Use Insulin - updated January 2022

* This 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.

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 December 2022

Value Based Design (VBD) Drugs

2023 NonNR Value Based Design (VBD) Drug
2022 Value Based Design (VBD) Drug List* - Updated January 2022

HSA Preventive Drugs

2023 NGF HSA Preventive Drug
2022 HSA Preventive Drug List* - Updated January 2022

Non-Payable Drugs

A prescription medication or drug that is not covered

Non-payable Drug List - updated December 2022

Payable Over-the-Counter (OTC) Drugs

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

Payable Over-the-Counter (OTC) Drug List - updated November 2019

Excluded Route of Administration

Prescription drug with an excluded pharmacy benefit route of administration that may not be covered under pharmacy benefit unless specified but may be covered under medical benefit

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

NetResults Formulary

The following lists are used by large employer group plans. (51 or more employees)

Drug Formulary List

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

2022 NetResults Formulary - updated October 2022

Restricted-Use Drugs

Drugs that are subject to a dispensing limit and/or require Prior Approval or Step Therapy

NetResults Restricted Use List - Opioids - updated December 2022
NetResults Quantity Limit Program Summary - updated October 2022
Restricted-Use Step Therapy Drugs - 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 December 2022

Value Based Design (VBD) Drugs

2023 NetResults Value Based Design (VBD) Drug List*
2022 NetResults Value Based Design (VBD) Drug List* - Updated January 2022

HSA Preventive Drugs

2023 NetResults HSA Preventive Drug List*
2022 NetResults HSA Preventive Drug List* - Updated January 2022

Payable Over-the-Counter (OTC) Drugs

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

Payable Over-the-Counter (OTC) Drug List - updated November 2019

BCBSND Health Insurance Market Individual, Small Group Formulary

BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime, SimplyBlue, DakotaBlue

The following lists are used by small employer group plans and on or off exchange health plans (non-employer group) available through the Health Insurance Marketplace, BCBSND or an Independent Agent.

Drug Formulary List

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

2023 Health Insurance Market Individual, Small Group Formulary - updated December 2022
2022 BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary - updated December 2022
2021 BlueCare, BlueDirect, BlueEssential, BluePartner, BluePrime and SimplyBlue Formulary - updated December 2022

Restricted-Use Drugs

Drugs that are subject to a dispensing limit and/or require Prior Approval or Step Therapy

Restricted-Use Prior Approval Drugs - updated December 2022
Restricted-Use Drug Dispensing Limits - updated October 2022
Restricted-Use Step Therapy Drugs - updated November 2022
Restricted-Use Opioids - updated December 2022
Restricted-Use Insulin - 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 December 2022

Value Based Design (VBD) Drugs

2023 BlueCare, BluePartner nonHDHP, BluePrime, SimplyBlue, BlueValue, DakotaBlue Value Based Design (VBD) Drug List*
2022 BlueCare, BluePartner nonHDHP, BluePrime and SimplyBlue Value Based Design (VBD) Drug List* - updated January 2022
2021 BlueCare, BluePartner nonHDHP, BluePrime and SimplyBlue Value Based Design (VBD) Drug List*

HSA Preventive Drugs

2023 BlueDirect, BluePartner HDHP Preventive Drug List*
2022 BlueDirect, BluePartner HDHP Preventive Drug List* - updated January 2022
2021 BlueDirect, BluePartner HDHP Preventive Drug List*

Payable Over-the-Counter (OTC) Drugs

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

Payable Over-the-Counter (OTC) Drug List - updated November 2019

BCBSND BlueValue Formulary

The following lists are used by on or off exchange health plans (non-employer group) available through the Health Insurance Marketplace, BCBSND or an Independent Agent.