The prescription for
a healthier you
Your pharmacy benefits might be your most important. And that means it’s important to us that you have all the tools and assistance you need to find your prescriptions, review your coverage, and discover savings. Sign in to MyBlue to learn more about your plan.
Important update: We're making changes to your pharmacy benefits on January 1, 2023. Learn more about the changes.
Coverage that covers all the bases
Learn about your medication coverage. Here’s the rundown.
"What’s covered and what’s not?"
Use the Medication Lookup Tool to learn about your coverage for prescribed medications. It might also list covered alternatives that can work for you.
"I’m managing a condition."
If you have a medication that is an injectable, or that you need to self-administer, you’ll want to look here.
"Can I get prescriptions at no additional cost?"
Possibly. Many preventive medications are covered through the Affordable Care Act. Look for your medication on this list.
The pharmacy that comes to you
With mail order pharmacy, most maintenance medications can be automatically refilled and shipped every 90 days at a lower cost.
No more running out of medicine or last-minute dashes to the store. It's a pharmacy for the 21st century.
To start, visit the Express Scripts Pharmacy®'
or call 1-800-892-5119.
Other Ways to Save on Your Medications
Find alternative options
If your medication isn't covered, the Medication Lookup Tool may list covered alternatives that can work for you.
Go for generics
They typically cost less than brand-name medications, are just as effective, and meet the same FDA requirements
Are value-based benefits part of your plan?
Certain medications used for conditions like asthma, diabetes, or coronary artery disease, may have reduced costs or no copayments.
More great coverage, from head to toe
Medical plans
Find the right plan to meet your health care needs and choose from a range of preferred doctors.
Blue 20/20 vision plan
Take a look at savings on routine eye exams, eyeglasses, contacts, and more.
Dental Blue®
Receive regular dental checkups and more from one of the largest networks in the country.
Frequently Asked Questions
Your pharmacy program is designed to provide you and your doctor with access to a wide variety of safe, clinically effective medications. We’ve carefully developed a substantial covered medication list that includes many medications that are available at affordable out-of-pocket costs. For the most current and complete information about covered medications, use our Medication Lookup tool.
Our covered medications list is based on a tiered cost structure. When you fill a prescription, the amount you pay at the pharmacy is determined by the tier your medication is on and your benefits.
Medications are placed on tiers according to a variety of factors, including what they’re used for, their cost, and whether equivalent or alternative medications are available. To find your out-of-pocket costs, login to MyBlue, access “My Account” and go to the Express Scripts link. Once you are on the Express Scripts site, look for the Price a Medication tool and find your medication.
Medication costs are going up and rising medication costs affect premiums for all of our members. To reduce costs and continue to cover a variety of safe, effective medications on your prescription plan, we regularly review our prescription coverage. Then, we’ll make coverage changes, or add benefits, to support your use of these therapies.
We make changes regularly to our prescription coverage. Changes may include:
- Adding a prior authorization requirement
- Moving a medication to a higher or lower tier
- Adding dosing or quantity limits
- Ending coverage for a medication
You can have certain prescriptions delivered right to your door when you order them through Express Scripts®', an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts.
In some cases, you’ll pay less for a 90-day supply of maintenance medications (also known as long-term medications) than you would for three 30-day supplies at a retail pharmacy. To get started with the mail order pharmacy, visit Express Scripts, and select Register. You can also call Express Scripts at 1-800-892-5119.
Our Quality Care Dosing program helps to ensure that the quantity and dosage meet the Food and Drug Administration’s (FDA) regulations, clinical standards, and manufacturer’s guidelines of the medications you receive.
Your doctor may request an exception for medications that are subject to Quality Care Dosing when medically necessary. To learn more, refer to the Blue Cross Blue Shield of Massachusetts Formulary
Your doctor is required to obtain Prior Authorization before prescribing specific medications. This ensures that your doctor has determined that this medication is necessary to treat you, based on specific medical standards. For the most current information about these medications, use our Medication Lookup tool.
Your doctor can download the Physician Request for Prior Authorization form (also called the Formulary Exception form) to request prior authorization or an exception to have your medication covered.
Step Therapy is a key part of our Prior Authorization program that allows us to help your doctor provide you with an appropriate and affordable medication treatment. Before coverage is allowed for certain costly “second-step” medications, we require that you first try an effective, but less expensive, “first-step” medication. Some medications may have multiple steps. For the most current information about these medications, use our Medication Lookup tool.