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.
Visit our Medicare member’s Check Drug Lists to view your plan’s formulary.
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.
Applies to midsize and large groups (plans offered by employers with more than 100 employees)
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.
Applies to those with Child Health Plus through Excellus BCBS.
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).
Some benefit plans require certain medications to be purchased through Express Scripts, Wegmans Home Delivery, or a mail order home delivery pharmacy.
Applies to groups (plans offered by employers)
Applies to those with Child Health Plus through Excellus BCBS
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: