Your Pharmacy Coverage
Pharmacy Networks
Medication Benefit Options
The Value of Generic Medications
Search For Information On A Medication
Medications That Are Not Covered
Medications That Require Prior Authorization
Quality Care Dosing
Step Therapy
Mail Service Pharmacy
Frequently Asked Questions
Glossary Of Pharmacy Terms
Specialty Pharmacy Network


At Blue Cross Blue Shield of Massachusetts, our goal is to provide a high-quality, affordable pharmacy benefit without compromising quality of care. Working closely with doctors, pharmacists, and other experts, we manage our program by asking ourselves:

  • How effective is a particular medication?
  • Which other medications are available to treat the same condition?
  • How does the cost of a particular medication compare to that of similar ones that treat the same condition?

Today, we have a wide variety of prescription medications available to help us live longer, healthier lives. But having so many choices comes at a cost. However, together, we have the ability to keep costs down and make sure quality medications remain accessible.

What You Can Do
The most important thing you can do is to be sure you stay informed.

  • Read the information on this website. It explains our formulary and our safety and effectiveness measures.
  • Use our search tool to find out information about medications you may be taking.
  • Learn how you can make the best use of your health care dollars.

How Your Copayment Works
Your copayment is the amount you pay for each prescription. Copayments are determined by the level, or tier, a medication is on.

Here's a quick overview of the standard pharmacy plan and how it lets you and your doctor choose from different medications with different copayments.
New Member ID Cards

We have recently updated our member ID cards. When you receive your new card some time this year, remember to provide the card to your physician(s) and pharmacies and ask that they update their records.

The new ID cards have additional space on the black magnetic strip on the back for storage of additional information for your health care providers. Please refer to your benefit literature for information about your pharmacy copayments or call the Member Service number printed on the front of your ID card. You can also access your pharmacy copayment information by registering for or logging into Member Self Service.
Previous Cards to be replaced by 11/1/2009
2-Tier Structure

Tiers (copay levels)

  1. Generic Drugs will have the lowest copayment.  The amount you pay is indicated by the first number.
  2. Brand-Name Drugs will have a slightly higher copayment, indicated by the second number.
3-Tier Structure

Tiers (copay levels)

  1. Generic Drugs, most will have the lowest copayment.  The amount you pay is indicated by the first number.
  2. Preferred Brand-Name Drugs will have a slightly higher copayment, indicated by the second number.
  3. Non-Preferred Drugs (the vast majority of which have generic or preferred brand-name alternatives) will require the highest copayment, indicated by the third number. 

The benefits described in this program are for our most commonly chosen health plans. Please check with your plan sponsor or employer for the specifics of the plan that covers you.

If you obtain health coverage through your employer, you may have a choice of pharmacy networks. In addition to our Standard Network, we've partnered with our pharmacy benefit manager, Express Scripts,®' Inc. (ESI) to offer two additional national pharmacy networks: The Select Network and The Select Choice Network. Learn more about our pharmacy networks.

Blue Cross and Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.
® Registered Marks of the Blue Cross and Blue Shield Association.
© 2009 Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross Blue Shield of Massachusetts HMO Blue, Inc.
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