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Prescription Formulary

What is a Formulary?

A formulary is a list of drugs covered by BCBSAZ Advantage that are believed to be a necessary part of a quality treatment program.

BCBSAZ Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. 

Can the formulary change?

Yes, drugs may be added or removed during the year.  If we remove drugs from our formulary or add restrictions to the drug, such as prior authorization, quantity limits and/or step therapy, or move a drug to a higher level in the formulary, we will notify members who take the drug at least 60 days before the change becomes effective.  We may also notify members when they request a refill, at which time they would receive a 60-day supply of the drug.  If the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

If you would like to request a coverage decision about your benefits and coverage; such as asking us to cover a Part D drug not listed on the drug list, asking us to waive a restriction on the plan's coverage for a drug, asking to pay a lower cost-sharing amount for a covered drug on a higher cost-sharing tier, or about the amount we will pay for your drugs, use the Coverage Determination Form.