Blue Cross Blue Shield (BCBS) formularies vary by state and plan type, as BCBS operates through independent regional companies. Most BCBS plans use a 4 to 5-tier formulary system with preferred generics, non-preferred generics, preferred brands, non-preferred brands, and specialty tiers. Your specific BCBS affiliate determines which medications are covered and at what cost.

Key Facts

BCBS operates through 34 independent companies, so formularies vary by state and plan
Most plans use a 4 or 5-tier system with copays ranging from $5 (generic) to 30%+ coinsurance (specialty)
BCBS Federal Employee Program (FEP) has its own national formulary covering 2.5 million members
Preferred pharmacy networks (e.g., CVS, Walgreens) offer lower out-of-pocket costs
Prior authorization turnaround is typically 24 to 72 hours for non-urgent requests
Many BCBS plans cover preventive medications at $0 under ACA requirements

Open Enrollment Reminder

ACA marketplace enrollment runs November 1 to January 15. Medicare Annual Enrollment is October 15 to December 7. Compare formularies for your medications before choosing a plan.

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Check Your Specific Plan's Formulary

Coverage varies by plan. Use our formulary checker tool to look up your exact copay and restrictions.

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Frequently Asked Questions

How do I find the BCBS formulary for my specific plan?

Visit your regional BCBS website (e.g., bcbsfl.com for Florida, bcbsil.com for Illinois) and log in to your member portal. Navigate to Pharmacy Benefits or Drug Search. You can also call your plan's pharmacy benefits number on your member ID card.

Does Blue Cross Blue Shield cover weight loss medications?

Coverage varies significantly by plan and state. Some BCBS plans now cover FDA-approved weight loss medications like Wegovy and Zepbound with prior authorization and documented medical necessity (typically BMI 30+ or BMI 27+ with comorbidities). Many employer-sponsored plans still exclude weight loss drugs.

Can I get 90-day supplies through BCBS?

Most BCBS plans offer 90-day supply options through mail-order pharmacies, often at a lower per-day cost than monthly fills. Check with your plan for preferred mail-order pharmacy partners. Some plans also allow 90-day fills at retail pharmacies.

Related Resources

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