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Pharmacy Benefits

Blue Advantage Formulary

The formulary is the list of medications that are covered by your Blue Advantage plan. You can use the formulary to find out if the medications you take are covered and at what cost to you. The formulary can also be helpful when working with your doctor to decide which medications can help treat you while also keeping your costs as low as possible.

Blue Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. 

Last Updated

Most changes in drug coverage happen on January 1, but we may add or remove drugs on the formulary during the year, move them to different cost-sharing tiers, or add new restrictions. We must follow the Medicare rules in making these changes.

Utilization Management

Certain covered drugs may have requirements or limits on coverage. Our staff works with a team of outside health care providers to help determine these requirements. They are designed to ensure that prescription drugs are used in a safe and effective way while helping to control drug plan costs. We've included a few examples below, but you can find out if your drug has any of these requirements or limits on coverage by looking in the formulary above.

Special note: Some Blue Advantage (HMO) Group Medicare Advantage plans do not offer preferred cost-sharing when you use a preferred pharmacy. You can still use a preferred pharmacy but may not pay less for your prescriptions than you would at a standard network pharmacy. If you are a Blue Advantage (HMO) – Group Medicare Advantage member, read your plan's Benefit Documents to see if this applies to you.

Express Scripts is an independent company that serves as the pharmacy benefit manager for Blue Cross and Blue Shield of Louisiana.