Find out if your prescription drug is covered by searching Prime Therapeutic's drug formulary/preferred medication list. Members – Benefits are subject to your specific plan. To get the best results, specific to your coverage, log in to your BlueAccess® account
and click on Rx Drugs. If you do not have a BlueAccess account, sign up today. Shoppers – If you are not currently covered by Blue Cross and Blue Shield of Kansas (BCBSKS), and are shopping either through HealthCare.gov or through the BCBSKS website for an individual or family plan, you will need to select the 2022 BCBSKS BlueCare/EPO Medication List. *Clicking on the wrong medication list could give you inaccurate information based on your coverage. It is important that you check your coverage before searching to see if a specific drug is covered on your plan.Find drugs (Formulary)
Helping you understand your prescription costs
The formulary is a list of our covered prescription drugs, including generic, brand name and specialty drugs.
See how we help keep your out-of-pocket costs low for the medications you and your family need.
Tier 1
Preferred Generic Drugs
Typically the most affordable drug type, and are equal to their brand name counterparts in quality, performance characteristics and intended use.
Tier 2
Preferred Brand Name Drugs
Preferred Generic Specialty Drugs
Preferred Brand Name Specialty Drugs
Preferred brand name: Proven to be safe, effective, and favorably priced compared to Non-preferred brands.
Specialty: Used to treat complex health conditions. Proven to be safe, effective, and favorably priced compared to Non-preferred specialty drugs.
Tier 1:
Generic Drugs
Typically the most affordable drug type, and are equal to their brand name counterparts in quality, performance characteristics and intended use.
Tier 2:
Preferred Brand Name Drugs
Proven to be safe, effective, and favorably priced compared to Non-preferred brands. Cheaper than Non-preferred brands but more expensive than generics.
Tier 3:
Non-preferred
Brand Name Drugs
Proven to be safe and effective. Typically have a higher cost because these drugs have either a generic or Preferred brand available.
Tier 4:
Preferred Specialty Drugs
Used to treat complex health conditions. Proven to be safe, effective, and favorably priced compared to Non-preferred specialty drugs.
Tier 5:
Non-preferred Specialty Drugs
Typically have a higher cost because these drugs have a Preferred specialty available.
- 2023 Benefits
- 2022 Benefits
Preferred Retail Pharmacy | Tier 1 (Generics): $5 copay; $15 copay for a 31 to 90-day supply Tier 2 (Preferred brand): 40% of our allowance ($350 max) for up to a 30-day supply; $1,050 maximum for 31 to 90-day supply | Tier 1 (Generics): $15 copay up to a 30-day supply; $40 copay for a 31 to 90-day supply Tier 2 (Preferred brand): $60 copay for up to a 30-day supply; $180 copay for a 31 to 90-day supply Tier 3 (Non-preferred brand): 60% of our allowance ($90 minimum) for up to a 30-day supply; $250 minimum for a 31 to 90-day supply Tier 4 (Preferred specialty): $85 copay Tier 5 (Non-preferred specialty): $110 copay Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program. | Tier 1 (Generics): $7.50 copay for up to a 30-day supply; $22.50 copay for a 31 to 90-day supply Tier 2 (Preferred brand): 30% of our allowance Tier 3 (Non-preferred brand): 50% of our allowance Tier 4 (Preferred specialty): 30% of our allowance Tier 5 (Non-preferred specialty): 30% of our allowance Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program. |
Mail Service Pharmacy | Not a benefit | Available to members with Medicare Part B primary only. Visit the Medicare page for more information. | Tier 1 (Generics): $15 copay Tier 2 (Preferred brand): $90 copay Tier 3 (Non-preferred brand): $125 copay Covers a 22 to 90-day supply. Nothing for the first 4 prescription fills or refills when you switch from certain brand name drugs to specific generic drugs. |
Specialty Pharmacy | Tier 2 (Preferred generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum) Specialty drugs are limited to a 30-day supply. | Tier 4 (Preferred specialty): $85 copay for up to a 30-day supply; $235 copay for a 31 to 90-day supply Tier 5 (Non-preferred specialty): $110 copay for up to a 30-day supply; $300 copay for a 31 to 90-day supply 90-day supply may only be obtained after third fill. | Tier 4 (Preferred specialty): $65 copay for up to a 30-day supply; $185 copay for a 31 to 90-day supply Tier 5 (Non-preferred specialty): $85 copay for up to a 30-day supply; $240 copay for a 31 to 90-day supply 90-day supply may only be obtained after third fill. |
This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s Federal brochures (Standard Option and Basic Option: RI 71-005; FEP Blue Focus: 71-017). All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.
Preferred Retail Pharmacy | Tier 1 (Generics): $5 copay; $15 copay for a 31 to 90-day supply Tier 2 (Preferred brand): 40% of our allowance ($350 max) for up to a 30-day supply; $1,050 maximum for 31 to 90-day supply | Tier 1 (Generics): $10 copay up to a 30-day supply; $30 copay for a 31 to 90-day supply Tier 2 (Preferred brand): $55 copay for up to a 30-day supply; $165 copay for a 31 to 90-day supply Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum) for up to a 30-day supply; $210 minimum for a 31 to 90-day supply Tier 4 (Preferred specialty): $85 copay Tier 5 (Non-preferred specialty): $110 copay Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program. | Tier 1 (Generics): $7.50 copay for up to a 30-day supply; $22.50 copay for a 31 to 90-day supply Tier 2 (Preferred brand):30%of our allowance Tier 3 (Non-preferred brand): 50% of our allowance Tier 4 (Preferred specialty): 30%of our allowance Tier 5 (Non-preferred specialty):30%of our allowance Tier 4 and 5 specialty drugs are limited to a 30-day supply; only one fill allowed. All refills must be obtained from the Specialty Drug Pharmacy Program. |
Mail Service Pharmacy | Not a benefit | Available to members with Medicare Part B primary only. Visit the Medicare page for more information. | Tier 1 (Generics): $15 copay Covers a 22 to 90-day supply. Nothing for the first 4 prescription fills or refills when you switch from certain brand name drugs to specific generic drugs. |
Specialty Pharmacy | Tier 2 (Preferred generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum) Specialty drugs are limited to a 30-day supply. | Tier 4 (Preferred specialty): $85 copay for up to a 30-day supply; $235 copay for a 31 to 90-day supply Tier 5 (Non-preferred specialty): $110 copay for up to a 30-day supply; $300 copay for a 31 to 90-day supply 90-day supply may only be obtained after third fill. | Tier 4 (Preferred specialty): $65 copay for up to a 30-day supply; $185 copay for a 31 to 90-day supply 90-day supply may only be obtained after third fill. |
This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s federal brochures (RI 71-005 and RI 71-017). All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.
Some prescription drugs and supplies need prior approval
To give prior approval, we need to confirm two things: that you’re using the drug to treat something we cover and that your health care provider prescribes it in a medically appropriate way. Your health care provider can request prior approval electronically, by fax or by mail. The full list of drugs that need to be approved, prior approval forms and additional information can be downloaded here.
Covered equivalents for drugs not on our formulary
Our three plan options have certain drugs that are not covered on their formularies. Each non-covered drug has safe and effective, alternative covered drug options. You can see the list of what’s not covered and available alternative options for Standard Option and Basic Option. FEP Blue Focus members can apply for coverage of a drug not covered on their formulary with the Non-Formulary Exception Process (NFE) form.