The results below contain both brand and generic medications identifiable by the text case
Drugs that are marketed with a brand name by the company that manufactures them.
Drugs that are chemically identical to brand name drugs, generally less expensive, meet the same standards of the Food and Drug Administration (FDA), and are marketed without the brand name as a generic medication.
We sort generic, brand name, and specialty medications into tiers based on safety, clinical effectiveness, clinical outcomes, cost, and innovation. Your prescription plan is based on a 2, 3, 4, 5, or 6 tier plan design. What you pay for medications at the pharmacy is determined by your prescription plan and which tier a medication is in.
To find out how many tiers your prescription plan has, you can do one of the following:
- Check your plan documents
- to your MyBlue account, and review your plan details
- Call Member Service at the number on your ID card
Medication is covered at no cost to the member.
Affordable Care Act (ACA)
This medication may be covered at no cost under the Affordable Care Act when prescribed by a doctor. For some medications, you must meet certain requirements for eligibility.
This medication is excluded from pharmacy coverage for members over 18. Please talk to your doctor about options available without a prescription.
Home Delivery Exclusion (HDE)
This medication is not available through the Mail Service Pharmacy. You can only fill it at a network retail pharmacy.
Long-term Medication (LM)
This maintenance medication is intended for long-term use. Please check your benefit materials to learn what your options are to obtain a 90-day (3 month) supply of the medication. In some cases, you may not be able to obtain a 30-day supply of the medication at a retail pharmacy.
This medication isn't covered because there are equally safe and effective alternatives covered at a lower cost. Your doctor may request an exception for coverage. If approved, the medication will be covered at the highest cost tier.
Oral Chemotherapy Parity Law (OC)
This medication is covered at no cost to you under the Massachusetts Oral Chemotherapy Parity Law.
Prior Authorization (PA)
Your doctor must get approval before this medication can be dispensed.
Quality Care Dosing (QCD)
A review that ensures both the quantity and dosage of the prescription meet FDA regulations, clinical standards, and manufacturer's guidelines.
Specialty Pharmacy (SP)
This medication is required to be filled through one of our retail pharmacies in the Specialty Pharmacy Network.
Step Therapy (ST)
Step therapy allows us to help your doctor provide you with a drug treatment that is safe, effective, and affordable. Before coverage is allowed for these "second-step" medications, you're required to try an effective and less expensive "first-step" medication.