Viewing the Formulary & Understanding Utilization Management

Blue Advantage Formulary

The formulary is the list of medications that are covered by your Blue Advantage plan. You can use the formulary to find out if the medications you take are covered and at what cost to you. The formulary can also be helpful when working with your doctor to decide which medications can help treat you while also keeping your costs as low as possible.

Blue 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.

Occasionally, our drug formulary may change during the year. These changes will be updated regularly, and you can find them by clicking the button below.

Utilization Management

Certain covered drugs may have requirements or limits on coverage. Our staff works with a team of outside health care providers to help determine these requirements. They are designed to ensure that prescription drugs are used in a safe and effective way while helping to control drug plan costs. We've included a few examples below, but you can find out if your drug has any of these requirements or limits on coverage by looking in the formulary above.

Did You Know?

Blue Advantage conducts drug utilization reviews for all members to ensure they are receiving safe and appropriate care. These reviews are especially important for members who have more than one doctor who prescribe their medications. We conduct reviews each time you fill a prescription and on a regular basis by reviewing our records. We look for medication problems such as:

• Possible medication errors
• Duplicate drugs that are unnecessary because you are taking another drug to treat the same medical condition
• Drugs that are not safe or appropriate because of your age or gender
• Possible harmful interactions between drugs you are taking at the same time
• Drug allergies
• Drug dosage errors

If we identify a medication problem during our drug utilization review, we will work with your doctor to correct the problem.

Now that you understand more about your pharmacy benefits, you're on the right path to maintaining and improving your health. Become a pro by learning how to easily get your needed prescriptions and about the prescription support programs offered by Blue Advantage!