It's important to know that Blue Cross Blue Shield of Massachusetts offers you an extensive list of pharmacies and covered medications. Use the information below to learn whether your medications are covered or have any additional requirements or limits on coverage.
A Formulary A list of certain drugs and their proper dosages. In some Medicare health plans, doctors must order or use only drugs listed on the health plan's formulary. is a list of drugs that our plan covers. Use the information below to learn whether your medications are covered or have any additional requirements or limits on coverage.
2013 Medicare HMO Blue ValueRx/PlusRx Formulary
2013 Medicare PPO Blue ValueRx/PlusRx Formulary
You can also use our online Formulary Search Tool to view the most current version of our formulary, or call Member Service for assistance.
For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. This ensures that our members use these drugs in a safe way. The types of additional requirements are listed below:
Prior authorization (prior approval) — For certain drugs, your doctor or health care provider will need to contact us before you fill your prescription.
Step therapy — For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your physician may have initially prescribed. For example, if Drug A and Drug B both treat your medical condition, we may require your doctor to prescribe Drug A first. If Drug A does not work for you, then we will cover Drug B.
Quality care dosing limits — For quality and safety reasons, there might be a limit on refills or how much of a drug can be received with each prescription. This process helps to ensure that the quantity and dosage of your medications remain consistent with manufacturer, clinical, and Food and Drug Administration (FDA) recommendations.
To see a complete list of drugs that require prior authorization or step therapy or have dosing limits, view the criteria documents below:
2013 Medicare Advantage Prior Authorization Criteria
2013 Medicare Advantage Step Therapy Criteria
2013 Medicare Advantage Quality Care Dosing Guidelines
If a drug you are taking requires prior authorization or step therapy from the Plan, please download and complete the
2013 Request for Medicare Prescription Drug Coverage Determination Form and ask your doctor to fax it to us at 1-617-246-8506.
Blue Cross Blue Shield of Massachusetts Medicare Advantage plans have contracts with 1,200 pharmacies in our Massachusetts network and over 61,900 pharmacies in our nationwide network. The link below provides a list of participating pharmacies. Pharmacies may have moved, closed, or may have been added or removed from the list after this directory was printed. To get current information about our Medicare Advantage plans' network pharmacies in your area, call our Member Service department at 1-800-200-4255, from February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday; and from October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week. TTY/TDD users should call 1-800-522-1254.
In most cases, your prescriptions are covered under our Medicare Advantage plans only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage.
Other prescription-related information you may need: