Commercial drug formulary

Our drug formulary is a regularly updated list of medications that have been approved by the Food and Drug Administration.

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.

Blue Care Network Formulary Tiers
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 copayCovered at middle copayCovered at the second tier copay
Tier 3 Nonformulary Medications not on the BCBSM/BCN Custom Formulary Covered at flat copay amountCovered at stated percentageNot covered unless the prescriber and BCN agree that the requested drug is medically necessaryCovered at highest copayCovered at the third tier copay
Tier 4
Formulary Specialty Drugs (Generics and Brands)
N/AN/AN/AN/ACovered 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/AN/AN/AN/ACovered 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