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Pharmacy Network

Drug Formulary

Brand name and generic prescription medications or drugs reimbursed at maximum payment levels.

Forms and Links:

Drug Formulary List - updated July 2020
Latest Additions and Deletions - updated July 2020
2019 BlueCare, BlueDirect, BlueEssential, BluePartnerand SimplyBlue Formulary - updated September 2020
2020 BlueCare, BlueDirect, BlueEssential, BluePartner and SimplyBlue Formulary - updated September 2020

Nonpayable Drugs

Prescription drugs not covered by BCBSND.

Nonpayable Drug List - updated September 2020

Restricted-Use Drugs

Drugs that have a dispensing limit, step therapy requirement and/or require prior approval from our pharmacy partner, Prime Therapeutics.

To submit a prior approval authorization request: 

1. Submit request electronically through CoverMyMeds  
   If you have not registered on this site, please do so. 
   OR
2. If you're unable to submit an electronic request, download a form from the Prime Therapeutics website using one of the links below, complete it and fax it to Prime Therapeutics at 877-480-8130.

• Dispensing Limits 
• Prior Authorization      
• Step Therapy                                  

See the guidelines for prior approval or have restricted-use drugs: 

Forms and Links:

Restricted-Use Prior Approval Drugs - updated September 2020
Restricted-Use Opioids - updated August 2020
Restricted-Use Step Therapy Drugs - updated August 2020
Restricted-Use Insulin - updated August 2020
Restricted-Use Drug Dispensing Limits - updated July 2020

Retail Pharmacy Medical Policy

We partner with Prime Therapeutics to validate and approve retail pharmacy medical policies which are available on their website.

Speciality Drugs

Medications or drugs that are generally high cost and may have other considerations such as special administration, limited availability, unique delivery and dispensing, or unique and/or required patient support or monitoring.

Specialty Drug List - updated September 2020

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.

2020 HSA Preventive Drug - updated February 2020

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

NetResults

Information specific to NetResults

NetResults Formulary - updated July 2020
NetResults HSA Preventive Drug List - updated January 2020
NetResults Restricted Use List - Opioids - updated August 2020
NetResults Quantity Limit Program Summary - updated April 2020