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  1. Home
  2. Pharmacy

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.

Sign in

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.

Get started

 

"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.

See what’s covered

 

"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.

See what’s covered

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.

Learn more

Go for generics

They typically cost less than brand-name medications, are just as effective, and meet the same FDA requirements

Learn more

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.

Learn More

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.

Find a Plan

Blue 20/20 vision plan

Take a look at savings on routine eye exams, eyeglasses, contacts, and more.

Learn more

Dental Blue®

Receive regular dental checkups and more from one of the largest networks in the country.

Learn more

Frequently Asked Questions

How does our pharmacy program work?

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.

How is the amount I pay at the pharmacy determined?

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.

Why does Blue Cross make changes to my prescription plan coverage?

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.

How often does Blue Cross make prescription plan changes?

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
How does the mail order pharmacy work?

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.

What is the Quality Care Dosing program?

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

How does Prior Authorization work?

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.

How does Step Therapy work?

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.

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ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación llamada 1-800-472-2689 (TTY: 711 ).

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ATANSYON: Si ou pale kreyòl ayisyen, sèvis asistans nan lang disponib pou ou gratis. Rele nimewo Sèvis Manm nan ki sou kat Idantitifkasyon w lan (Sèvis pou Malantandan Rele 1-800-472-2689 TTY: 711 ).

LƯU .: Nếu quý vị n.i Tiếng Việt, c.c dịch vụ hỗ trợ ng.n ngữ được cung cấp cho quý vị miễn ph.. Gọi cho Dịch vụ Hội vi.n theo số tr.n thẻ ID của quý vị Cuộc gọi 1-800-472-2689 (TTY: 711 ).

ВНИМАНИЕ: если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Позвоните в отдел обслуживания клиентов по номеру, указанному в Вашей идентификационной карте вызов  1-800-472-2689 (телетайп: 711 ).

ការជូនដំណឹង៖ ប្រសិនប. ើអ្នកនិយាយភាសា ខ្មែរ សេ  វាជំនួយភាសាឥតគិតថ្លៃ គឺអាចរកបានសម្  រាប ់អ្នក។ សូមទូរស័ព្ទទ ៅផ ្នែ កសេ  វាសមា  ជិកតាមល េខន  ៅល.  ើប ័ណ្ណ សម្  គាល ់ខ្លួ ខ្លួ នរប ស់អ្នក ហៅ  1-800-472-2689 (TTY: 711) ។

ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativa chiamata  1-800-472-2689 (TTY: 711 ).

참고 : 한국어를 사용하는 경우 언어 지원 서비스를 무료로 사용할 수 있습니다. 신분증에있는 전화 번호 1-800-472-2689 (TTY : 711)로 회원 서비스에 연락하십시오.

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ध्यान दें: य दि  आप ह िन् दी बोलते ह ैं, तो भा षा  सहाय  ता  सेवा एँ, आप के लि ए नि :शुल्क  उपलब्ध ह ैं। सदस्य  सेवा ओं को आपके आई.डी. कार  ्ड पर दि ए गए नंबर पर कॉल करें  कॉल 1-800-472-2689 ( टी .टी .वा ई.: 711).

ધ્યાન આપો:  જો તમે ગુજરા તી બોલતા  હો, તો તમને ભા ષા કીય  સહાય  તા  સેવા ઓ વિ ના  મૂલ્યે  ઉપલબ્ધ છે. તમા રા  આઈડી કાર  ્ડ પર આપેલા  નંબર પર Member Service  ને કૉલ કરો કૉલ કરો 1-800-472-2689 (TTY: 711).

PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag 1-800-472-2689 (TTY: 711 ).

お知らせ:日本語をお話しになる方は無料の言語アシスタンスサービスをご利用いただけます。ID カードに記載の電話番号を使用してメンバーサービスまでお電話ください 呼び出す 1-800-472-2689(TTY: 711 )。

ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstützung zur Verfügung. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen 1-800-472-2689 (TTY: 711 ).

ຂໍ້ຄວນໃສ່ໃຈ: ຖ້າເຈົ້າເວົ້າພາສາລາວໄດ້, ມີການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໃຫ້ທ່ານໂດຍບໍ່ເສຍຄ່າ. ໂທ ຫາ ຝ່າຍບໍລິການສະ ມາ ຊິກທີ່ໝາຍເລກໂທລະສັບຢູ່ໃນບັດຂອງທ່ານ ໂທ 1-800-472-2689 (TTY: 711).

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