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: All pharmacy benefit information is effective January 1, 2023. For immediate assistance or questions about your pharmacy coverage, call Team Blue at the Member Service number on the front of your ID card.
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 service 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 using the mail service pharmacy, sign into MyBlue or Commercial members can call CVS Customer Care at 1-877-817-0477 (TTY: 711). Medicare Advantage members can call CVS Customer Care at 1-877-817-0493 (TTY: 711).
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.
Fill maintenance medications in 90-day supplies
Also known as long-term medications, maintenance medications are used to treat chronic or ongoing conditions. Save money when you order them through the mail service pharmacy.
Fill prescriptions at an in-network pharmacy
There's more than 65,000 retail pharmacies in our network. Use our Pharmacy Locator tool to find one near you.
More great coverage, from head to toe
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.
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.
You have access to an extensive pharmacy network, which includes CVS Pharmacy, Rite Aid, and Walgreens pharmacies as well as thousands of independent and most major chain pharmacies nationwide. To find an in-network pharmacy location near you, use our pharmacy locator tool.
Our list of covered medications is based on a tiered cost structure. When you fill a prescription, the amount you pay at the pharmacy is determined by your medication's tier and your benefits.
Medications are placed into tiers according to a variety of factors, including what they’re used for, their cost, and whether equivalent or alternative medications are available. Sign into MyBlue to find your out-of-pocket costs.
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. When changes occur, medications may:
- No longer be covered (exceptions may be granted)
- Be excluded from coverage (exceptions won't be granted)
- Switch tiers
- Have new quantity or dosage limits
- Require Prior Authorization
- Require Step Therapy
- Be added to the list of covered medications
- Be designated as preferred
Save 33% when you order most maintenance medications, also known as long-term medications, in 90 day-supplies through the mail service pharmacy. Get them delivered right to your door at no additional cost for standard delivery. To start using the mail service pharmacy, sign into MyBlue or Commercial members can call CVS Customer Care at 1-877-817-0477 (TTY: 711). Medicare Advantage members can call CVS Customer Care at 1-877-817-0493 (TTY: 711).
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.