Commercial drug formulary
Our drug formulary is a regularly updated list of medications that have been approved by the Food and Drug Administration.
- Formulary Quick Guide for Members (PDF) — our most commonly prescribed drugs
- Custom Formulary (PDF) — our complete formulary
We use the clinical judgment of Michigan physicians, pharmacists and other experts in health care diagnosis and treatment to organize our formulary into tiers based on each drug's clinical effectiveness, safety and opportunity for cost savings.
| Tiers | Flat Rx rider | Percentage Rx rider | Two-tier Rx rider | Three-tier Rx rider | Three-Tier + Specialty Rx rider (Five-tier) |
|---|---|---|---|---|---|
| Tier 1 Formulary Preferred All generic medications, some select brand name medications |
Covered at flat copay amount | Covered at stated percentage | Covered at lowest copay | Covered at lowest copay | Covered at lowest copay |
| Tier 2 Formulary Options Brand-name medications |
Covered at flat copay amount | Covered at stated percentage | Covered at highest copay | Covered at middle copay | Covered at the second tier copay |
| Tier 3 Nonformulary Medications not on the BCBSM/BCN Custom Formulary | Covered at flat copay amount | Covered at stated percentage | Not covered unless the prescriber and BCN agree that the requested drug is medically necessary | Covered at highest copay | Covered at the third tier copay |
| Tier 4 Formulary Specialty Drugs (Generics and Brands) |
N/A | N/A | N/A | N/A | Covered at the fourth tier coinsurance with a limit per prescription and an annual out-of-pocket maximum per member for specialty drugs |
| Tier 5 Non-formulary Brand Specialty Drugs |
N/A | N/A | N/A | N/A | Covered at the fifth tier coinsurance with a limit per prescription and an annual out-of-pocket maximum per member for specialty drugs. |
page modified 09/23/2011