What is a Formulary?
A formulary (also known as a drug list) is a list of brand-name and generic drugs (or medications) that are covered under your prescription drug benefit. If you have a question about coverage, pricing, or rules, contact Customer Care using the number on the back of your member card.
Formularies
Medicare / Dual Special Needs Plans (D-SNP)
Visit our Medicare member’s Check Drug Lists to view your plan’s formulary.
Small Group / Individuals and Families / College Plans
Applies to small groups (plans offered by employers with 100 employees or less), individuals and families who purchase their health plan on their own from NY State of Health (including the Essential Plan) or directly from Excellus BCBS, and college plans.
- 2023 3-Tier Formulary - 2981Open a PDF
- 2024 3-Tier Formulary - 2981Open a PDF
Upcoming Changes
- 2023 3-Tier Formulary - 2981Open a PDF
- 2024 3-Tier Formulary - 2981Open a PDF
Midsize / Large Group
Applies to midsize and large groups (plans offered by employers with more than 100 employees)
- 3-Tier Formulary - 2950Open a PDF
- 2023 3-Tier State Mandate Formulary - 2950Open a PDF
- 2024 3-Tier State Mandate Formulary - 2950Open a PDF
- Preferred Value Formulary - 3295Open a PDF
- Preferred Value State Mandate Formulary - 5578Open a PDF
- National Preferred Formulary - 3624Open a PDF
Upcoming Changes
- 3-Tier Formulary - 2950Open a PDF
- 2023 3-Tier State Mandate Formulary - 2950Open a PDF
- 2024 3-Tier State Mandate Formulary - 2950Open a PDF
- Preferred Value Formulary - 3295Open a PDF
- Preferred Value State Mandate Formulary - 5578Open a PDF
Medicaid Managed Care / HARP
Applies to those with Blue Choice Option, HMOBlue Option, or Blue Option Plus
Beginning April 1, 2023, all Medicaid members enrolled in Blue Choice Option, HMO Blue Option, and Blue Option Plus will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.
Learn more about the transition of the pharmacy benefit from Blue Choice Option, HMO Blue Option, and Blue Option Plus to NYRx, the Medicaid Pharmacy Program.
Access general information about NYRx, the Medicaid Pharmacy Program, along with additional information for Members and Providers.
- Behavioral Health TransitionOpen a PDF
- NYS DOH Single Statewide Medication Assisted Treatment
Child Health Plus
Applies to those with Child Health Plus through Excellus BCBS.
- Formulary – 2977Open a PDF
Upcoming Changes
- Child Health Plus Formulary - 2977Open a PDF
Other Offerings and Programs
- Medication Assurance Program and Drug ListOpen a PDF
- Patient Assurance Program and Drug ListOpen a PDF
- Contraceptive List for plans without Prescription Drug coverageOpen a PDF
- Preventive Drug List for select HDHP plansOpen a PDF
- Preventive Drug List - National Preferred Formulary for select HDHP plansOpen a PDF
Specialty Drug List
Applies to commercial groups (plans offered by employers), individuals and families who purchase their health plan on their own from NY State of Health (including the Essential Plan) or directly from Excellus BCBS, and Child Health Plus through Excellus BCBS.
The following specialty drugs must be purchased from one of our participating specialty pharmacies in order to receive coverage under your prescription drug benefit (for medications that are self-administered).
- Specialty Drug List (Self-Administered Drugs)Open a PDF
- Bassett Specialty Drug ListOpen a PDF
- National Preferred Formulary - Specialty Drug ListOpen a PDF
Mandatory Maintenance Medication List
Some benefit plans require certain medications to be purchased through Express Scripts, Wegmans Home Delivery, or a mail order home delivery pharmacy.
- Medications Requiring Mail Order or Home Delivery ServiceOpen a PDF
- National Preferred Formulary - Medications Requiring Mail Order or Home Delivery ServiceOpen a PDF
Specific Employer Groups
- Bassett Healthcare Network - Medications Requiring Mail Order or Home Delivery ServiceOpen a PDF
- Rochester Regional Health System - Medications Requiring Mail Order or Home Delivery ServiceOpen a PDF
Prior Authorization and Step Therapy Lists
Group Plans (Small, Midsize, and Large)
Applies to groups (plans offered by employers)
- 3-Tier Prior Authorization and Step Therapy ListOpen a PDF
- 2023 3-Tier State Mandate Formulary Prior Authorization and Step Therapy ListOpen a PDF
- 2024 3-Tier State Mandate Formulary Prior Authorization and Step Therapy ListOpen a PDF
- National Preferred Formulary Prior Authorization and Step Therapy ListOpen a PDF
Child Health Plus
Applies to those with Child Health Plus through Excellus BCBS
- Child Health Plus Prior Authorization and Step Therapy ListOpen a PDF
Exception Review Requests
Some drugs require an exception review before they will be covered. To request an exception review for a drug that requires prior authorization, step therapy, or has a quantity limit, you may:
- Speak with your doctor, who may submit a request on your behalf
- Contact Customer Care at 1-800-499-1275 (TTY 711) or by fax at 1-800-956-2397
- Submit a Prescription Drug Coverage Request via secure eForm
