PRESCRIPTION DRUG LISTS

A drug list, is a list of drugs available to Blue Cross and Blue Shield of Illinois (BCBSIL) members. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. These prescription drug lists have different levels of coverage, which are called "tiers". Generally, if you choose a drug that is a lower tier, your out-of-pocket costs for a prescription drug will be less. Your doctor should consult the Drug List when prescribing drugs for you. This may help lower your out-of-pocket costs.

If you are a BCBSIL member, log in to your Blue Access for MembersSM account to check your drug list and learn more about your prescription drug benefits. Be sure to review your benefit materials for details. If you have any questions about your prescription drug benefits, call the number on your member ID card.

Please note: Health plans may administer medical and pharmacy coverage separately for select drugs. Some drugs are covered under your medical plan instead of your pharmacy benefits. These can include drugs that must be given to you by a health care provider. These drugs are often given to you in a hospital, doctor’s office or health care setting. Examples of these drugs are contraceptive implants and chemo infusion. If you are taking or prescribed a drug that is not on your plan's Drug List, call the number on your member ID card to see if the drug may be covered by your medical plan.

Prescription Drug Lists for Metallic Individual Plans

The drug lists below are used with your health plan if all of these apply to you:

  • You enrolled in a plan on your own (instead of through your employer) and
  • Your plan is a "metallic" health plan, which can include a Gold, Silver, Bronze or Catastrophic plan.

Your prescription drug benefits through BCBSIL is based on a Drug List, which is a list of drugs considered to be safe and cost-effective.

To search for a drug name within the PDF Drug List document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking for and click on Search.

View your current drug list effective January 1, 2021:

Starting January 1, 2021, some changes were made to the prescription drug benefit. See the 2021 changes.

You, your prescribing health care provider, or your authorized representative, can ask for a Drug List exception if your drug is not on (or is being removed from) the Drug List, or the drug required as part of step therapy or dispensing limits has been found to be (or likely to be) not right for you or does not work as well in treating your condition. To request this exception, you, your prescriber, or your authorized representative, can call the number on the back of your ID card to ask for a review. BCBSIL will let you, your prescriber (or authorized representative) know the coverage decision within 72 hours after they receive your request. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable).

If you have a health condition that may jeopardize your life, health or keep you from regaining function, or your current drug therapy uses a non-covered drug, you, your prescriber, or your authorized representative, may be able to ask for an expedited review process. BCBSIL will let you, your prescriber (or authorized representative) know the coverage decision within 24 hours after they receive your request for an expedited review. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable). Call the number on the back of your ID card if you have any questions.

If you are a BCBSIL member, log in to your Blue Access for MembersSM account to check your drug list and learn more about your prescription drug benefits.

Prescription Drug Lists for Grandfathered & Transitional Individual Plans

The drug list below is used with your health plan if all of these apply to you:

  • You enrolled in a plan on your own (instead of through your employer),
  • Your current BCBSIL policy was effective before January 1, 2014, and
  • Your plan is not a "metallic" health plan.

Your prescription drug benefits through BCBSIL is based on the Basic Drug List or the Basic Annual Drug List, which is a list of drugs considered to be safe and effective:

If you are a BCBSIL member, log in to your Blue Access for MembersSM account to check your drug list and learn more about your prescription drug benefits.

View your current drug list:

Prescription Drug Lists for Employer-offered Plans: Large Group (51 or more)

The drug lists below are used for BCBSIL health plans that are offered through your employer. If your company has 51 or more employees, your prescription drug benefits through BCBSIL may be based on one of the following drug lists. These drug lists are a continually updated list of covered drugs.

If you are a BCBSIL member, log in to your Blue Access for MembersSM account to check your drug list and learn more about your prescription drug benefits.

View your current drug list:

Prescription Drug Lists for Employer-Offered Metallic Plans: Small Group (1–50)

The drug lists below are used with BCBSIL "metallic" health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans.

If your company has 1–50 employees, your prescription drug benefits through BCBSIL are based on a Drug List, which is a list of drugs considered to be safe and effective.

If you are a BCBSIL member, log in to your Blue Access for MembersSM account to check your drug list and learn more about your prescription drug benefits.

View your drug list effective January 1, 2021:

Starting January 1, 2021, some changes were made to the prescription drug benefit. See the 2021 changes.

These drug lists’ coverage ended December 31, 2020, with the exception of a plan with an off-cycle 2021 renewal date. Check your benefit materials for details.

Starting January 1, 2020, some changes were made to the prescription drug benefit. View the 2020 changes.

You, your prescribing health care provider, or your authorized representative, can ask for a Drug List exception if your drug is not on (or is being removed from) the Drug List, or the drug required as part of step therapy or dispensing limits has been found to be (or likely to be) not right for you or does not work as well in treating your condition. To request this exception, you, your prescriber, or your authorized representative, can call the number on the back of your ID card to ask for a review. BCBSIL will let you, your prescriber (or authorized representative) know the coverage decision within 72 hours after they receive your request. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable).

If you have a health condition that may jeopardize your life, health or keep you from regaining function, or your current drug therapy uses a non-covered drug, you, your prescriber, or your authorized representative, may be able to ask for an expedited review process. BCBSIL will let you, your prescriber (or authorized representative) know the coverage decision within 24 hours after they receive your request for an expedited review. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable). Call the number on the back of your ID card if you have any questions.

Prescription Drug Lists for Employer-offered Non-Metallic Plans: Small Group (1–50)

The drug lists below are used for BCBSIL health plans that are offered through your employer. These health plans are not a "metallic" health plan and were effective before January 1, 2014.

If your company has 1–50 employees, your prescription drug benefits through BCBSIL may be based on the Basic Drug List, Basic Annual Drug List, Enhanced Drug List or the Enhanced Annual Drug List. These drug lists are a list of drugs considered to be safe and effective.

View your current drug list:

If you are a BCBSIL member, log in to your Blue Access for MembersSM account to check your drug list and learn more about your prescription drug benefits.