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Prescription Drug Information

Prescription drugs are an important part of your health care coverage. If you have prescription drug coverage through Blue Cross and Blue Shield of Oklahoma (BCBSOK), we want to help you better understand your prescription drug coverage and options, including convenient services and any limitations. Here you'll find helpful information and forms you need.

This is only a brief description of some of the prescription drug benefits. Not all benefits are offered by all health plans. For more complete details, including benefits, limitations and exclusions, please refer to your benefit materials.

Prescription Drug Lists for Metallic Individual Plans

A prescription drug list, or formulary, is a list of preferred drugs available to BCBSOK members. Medications not listed on the formulary may require you to pay more out-of-pocket. Within a drug list, generally the lower the tier, the lower the cost of the drug.

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, Multi-State or Catastrophic plan.

Your prescription drug benefits through BCBSOK may be based on one of two different drug lists:

  • A Standard Drug List is a list of preferred drugs which are considered to be safe and cost-effective.
  • A Generics Plus Drug List is a smaller version of the Standard Drug List. It covers drugs for the major drug classes, but includes mostly generic drugs and fewer brand-name drugs.

These drug lists are effective January 1, 2015:

Want to know which drug list (formulary) your Oklahoma Health Insurance Marketplace plan uses?

You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List (also known as a formulary). To request this exception, you, or your prescriber, can call the number on the back of your ID card to ask for a review. 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, or your prescriber, may be able to ask for an expedited review process. BCBSOK will let you, and your prescriber, know the coverage decision within 24 hours after they receive your request for an expedited review. If the coverage request is denied, BCBSOK will let you and your prescriber 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.

View the Commonly Prescribed Maintenance Drug List  (These are drugs taken regularly for an ongoing condition)

If you're already a BCBSOK member, log in to Blue Access for MembersSM to learn more about your pharmacy benefits.

Prescription Drug Lists for Grandfathered Individual Plans

A prescription drug list, or formulary, is a list of preferred drugs available to BCBSOK members. Medications not listed on the drug list may require you to pay more out-of-pocket. Within a drug list, generally the lower the tier, the lower the cost of the drug.

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 BCBSOK policy was effective before January 1, 2014, and
  • Your plan is not a "metallic" health plan.

Your prescription drug benefits through BCBSOK are based on the Generics Plus Drug List, which is a list of preferred drugs considered to be safe and cost-effective. It covers drugs for the major drug classes, but includes mostly generic drugs and fewer brand-name drugs.

This updated drug list applies starting January 1, 2015:

View the Commonly Prescribed Maintenance Drug List  (These are drugs taken regularly for an ongoing condition)

If you're already a BCBSOK member, log in to Blue Access for MembersSM to learn more about your pharmacy benefits.

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

A prescription drug list, or formulary, is a list of preferred drugs available to BCBSOK members. These drugs are considered to be safe and cost-effective. Medications not listed on the drug list may require you to pay more out-of-pocket. Within a drug list, generally the lower the tier, the lower the cost of the drug.

The drug lists below are used for BCBSOK health plans that are offered through your employer. If your company has 51 or more employees, your BCBSOK prescription drug benefits may be based on the Standard Drug List or the Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for the major drug classes.

These Drug Lists are effective starting January 1, 2015:

View the Commonly Prescribed Maintenance Drug List  (These are drugs taken regularly for an ongoing condition)

If you're already a BCBSOK member, log in to Blue Access for MembersSM to learn more about your pharmacy benefits.

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

A prescription drug list, or formulary, is a list of preferred drugs available to BCBSOK members. These drugs are considered to be safe and cost-effective. Medications not listed on the drug list may require you to pay more out-of-pocket. Within a drug list, generally the lower the tier, the lower the cost of the drug.

The drug lists below are used for BCBSOK "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 BCBSOK prescription drug benefits may be based on the Standard Drug List or the Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for the major drug classes of drugs.

These drug lists are effective January 1, 2015:

These drug lists were effective starting January 1, 2014 (Coverage ends December 31, 2014, with the exception of a plan with an off-cycle 2015 renewal date. Check your benefit materials for details.):

Want to know which drug list (formulary) your Oklahoma Health Insurance Marketplace plan uses?

You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List (also known as a formulary). To request this exception, you, or your prescriber, can call the number on the back of your ID card to ask for a review. 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, or your prescriber, may be able to ask for an expedited review process. BCBSOK will let you, and your prescriber, know the coverage decision within 24 hours after they receive your request for an expedited review. If the coverage request is denied, BCBSOK will let you and your prescriber 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.

View the Commonly Prescribed Maintenance Drug List  (These are drugs taken regularly for an ongoing condition)

If you're already a BCBSOK member, log in to Blue Access for MembersSM to learn more about your pharmacy benefits.

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

A prescription drug list, or formulary, is a list of preferred drugs available to BCBSOK members. These drugs are considered to be safe and cost-effective. Medications not listed on the drug list may require you to pay more out-of-pocket. Within a drug list, generally the lower the tier, the lower the cost of the drug.

The drug lists below are used for BCBSOK 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 BCBSOK prescription drug benefits may be based on the Standard Drug List or the Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for the major drug classes.

These updated drug lists apply starting January 1, 2015:

View the Commonly Prescribed Maintenance Drug List  (These are drugs taken regularly for an ongoing condition)

If you're already a BCBSOK member, log in to Blue Access for MembersSM to learn more about your pharmacy benefits.

Search Drug List and Find a Pharmacy

If your health plan includes BCBSOK prescription drug benefits, these are administered by Prime Therapeutics, the pharmacy benefit manager (PBM).

Visit Prime Therapeutics  to:

  • Search for prescription drugs
  • Find a pharmacy
  • Order mail service refills or new prescriptions online
  • View status of coverage for your drugs
  • Download forms and brochures
  • Get drug cost estimates
  • Learn more about drug side effects or interactions

BCBSOK has a broad network of contracting pharmacies. To use your benefits, simply find a contracting pharmacy close to you and present your member ID card.

What You Should Know About Dispensing Limits

  • Your prescription drug coverage includes limits on certain medications.
  • Limits may include quantity of covered medication per prescription, quantity of covered medication in a given time period and coverage only for members within a certain age range.
  • These limits reflect generally accepted pharmaceutical manufacturers' guidelines.
  • They also help encourage medication use as intended by the U.S. Food and Drug Administration (FDA).
  • For more information, view the Standard Drug List Dispensing Limits  and Generics Plus Drug List Dispensing Limits .

Specialty Prescription Drugs and Prime Specialty Pharmacy

Your prescription drug benefit may include a specialty pharmacy program through Prime Therapeutics Specialty Pharmacy (Prime Specialty Pharmacy).

Specialty medications are those used to treat serious or chronic conditions. Examples include hepatitis C, hemophilia, multiple sclerosis, and rheumatoid arthritis. These drugs are typically given by injection, but may be topical or taken by mouth. They often require careful adherence to treatment plans, have special handling or storage requirements, and may not be stocked by retail pharmacies.

View the Specialty Pharmacy Program Drug List , which includes a reminder about coverage for self-administered specialty medications.

When you purchase specialty medications through Prime Specialty Pharmacy, you can have your self-administered specialty medications delivered directly to you, or to your doctor's office. You also receive at no additional charge:

  • Support services for managing your drug therapy
  • Educational materials about your particular condition
  • Help with managing potential medication side effects
  • 24/7/365 customer service phone access

Note: Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC, a pharmacy benefit management company. BCBSOK contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSOK, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

Prior Authorization/Step Therapy Program

The prior authorization/step therapy program is designed to encourage safe, cost-effective medication use.


This program may be part of your prescription drug benefit plan. To find out if your specific benefit plan includes the prior authorization/step therapy program, and which drugs are part of your plan, refer to your benefit materials, or call the number on the back of your ID card.


Prior Authorization

Under this program, your doctor will be required to request pre-approval, or prior authorization, through Blue Cross and Blue Shield of Oklahoma in order for you to get benefits for the select drugs.

  • Below are drug categories and specific medications for which a prior authorization program may be included as part of your prescription drug benefit plan.
  • Please note that drug categories may be added and the medications listed are only examples. Call the number on the back of your ID card with questions about a specific medication.
  • As always, cost is only one factor in choosing medication and treatment decisions are between you and your doctor.
Prior Authorization CategoryTargeted medications within category1,2
Androgens/Anabolic Steroids Anadrol-50, Androderm, Androgel, Android, Androxy, Aveed, Axiron, danazol, Delatestryl, Depo-Testosterone, First-Testosterone, Fortesta, Methitest, Oxandrin, Striant, Testim, Testred, Vogelxo
Antifungal Agents Noxafil, Vfend
Cushing's Disease Signifor
Cystic Fibrosis Kalydeco
Doxycycline/Minocycline Doxycycline products: Acticlate, Adoxa, Alodox, Avidoxy DK, Doryx (and generic equivalents), doxycycline, Monodox, Morgidox Kit, Nicazeldoxy, Nutridox Kit, Ocudox Kit, Oracea, Oraxyl, Vibramycin
Minocycline products: Dynacin, Minocin, Minocin Kit, Solodyn (and generic equivalents)
Enzyme Deficiencies Kuvan
Erectile Dysfunction Agents Caverject, Cialis, Edex, Levitra, Muse, Staxyn, Stendra, Viagra
Erythropoiesis Stimulating Agents (ESAs) Aranesp, Epogen, Procrit
Familial Hypercholesterolemia Juxtapid, Kynamro
Growth Hormones Egrifta, Genotropin, Humatrope, Norditropin, Nutropin, Nutropin AQ, Omnitrope, Saizen, Serostim, Tev-Tropin, Zorbtive
Hepatitis B & C Infergen, Harvoni, Olysio, Pegasys, PegIntron, Sovaldi
Huntington's Chorea Xenazine
Idiopathic Thrombocytopenic Purpura (ITP) Nplate, Promacta
Inherited Autoinflammatory Disorders Arcalyst, Ilaris
Insulin Agents Apidra, Humalog, Humalog Mix 75/25, Humalog Mix 50/50, Humulin R U-100, Humulin N, Humulin 70/30
Multiple Sclerosis Amprya
Narcolepsy Nuvigil, Provigil, Xyrem
Oral/Nasal Fentanyl Abstral, Actiq, Fentora, Lazanda, Onsolis, Subsys
Opioid Dependence Bunavail, Suboxone, Subutex, Zubsolv
Osteoporosis (Bone loss) Forteo
Pituitary Hormone H.P. Acthar Gel
Pulmonary Arterial Hypertension (PAH) Adcirca, Adempas, Opsumit, Orsenitram, Revatio, Tracleer
Self-Administered Oncology Afinitor, Afinitor Disperz, Bosulif, Caprelsa, Cometriq, Erivedge, Gilotrif, Gleevec, Hexalen, Hycamtin, Iclusig, Imbruvica, Inlyta, Jakafi, Lysodren, Matulane, Mekinist, Nexavar, Oforta, Pomalyst, Revlimid, Sprycel, Stivarga, Sutent, Sylatron, Tafinlar, Tarceva, Targretin, Tasigna, Temodar, Thalomid, Tretinoin, Tykerb, Votrient, Xalkori, Xeloda, Xtandi, Zelboraf, Zolinza, Zykadia, Zydelig, Zytiga
Short Bowel Syndrome Gattex
Urea Cycle Disorders Buphenyl, Ravicti
Xyrem Xyrem

1 Additional categories may be added and the program may change from time to time.

2 Third-party brand names are the property of their respective owners.


More information is available in the prior authorization member flier .


Step Therapy

The step therapy program requires that you have prescription history for a "first-line" medication before your benefit plan will cover a "second-line" drug.


  • A first-line drug is recognized as safe and works well in treating a specific medical condition, as well as being a cost-effective treatment option.
  • A second-line drug is a less-preferred or likely a more costly treatment option.

Step 1: If possible, your doctor should prescribe a first-line medication right for your condition.


Step 2: If you and your doctor decide that a first-line drug is not right for you or is not as good in treating your condition, your doctor should submit a prior authorization request for coverage of the other drug.


  • Below are drug categories and specific medications for which a step therapy program may be included as part of your prescription drug benefit plan.
  • Step therapy does not apply to the generic equivalents for these medications (if available), so if you and your doctor decide the generic equivalent is best for you, prior authorization is not required.
  • These medications are listed along with the first use approved by the U.S. Food and Drug Administration, but may be prescribed for conditions other than those noted and would still be part of the step therapy program.
  • Please note that drug categories may be added and the medications listed are only examples. Call the number on the back of your ID card with questions about a specific medication.
  • As always, cost is only one factor in choosing medication and treatment decisions are between you and your doctor.
Step Therapy CategoryPrescription Drugs within the Category3,4
Antidepressants (depression) Aplenzin, Brintellix, Celexa, Cymbalta, desvenlafaxine ER tabs, Desvenlafaxine, Effexor, Effexor XR, Fetzima, fluoxetine 60 mg tabs, Forfivo XL, fumarate, Lexapro, Luvox CR, maprotiline, Oleptro, Paxil, Paxil CR, Pexeva, Pristiq, Prozac, Prozac Weekly, Remeron, Remeron SolTab, venlafaxine XR, Viibryd, Viibryd Starter Kit, Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zoloft
Cholesterol (lipid management) Advicor, Altoprev, Lescol, Lescol XL, Lipitor, Liptruzet, Livalo, Mevacor, Pravachol, Simcor, Vytorin, Zocor
COX-2 /NSAID GI Protectant (pain management) Celebrex, Duexis, Vimovo
Diabetes (GLP-1 Receptor Agonists) Bydureon, Byetta, Tanzeum, Trulicity, Victoza
Glucose Test Strips All non-preferred brand test strips and disks
Infertility Gonal F, Gonal F RFF
Iron Chelator Ferriprox
Multiple Sclerosis Aubagio, Avonex, Extavia, Gilenya
Proton Pump Inhibitors
(gastroesophageal reflux disease)
AcipHex, Dexilant, Esomeprazole Strontium, First lansoprazole suspension kit, First omeprazole suspension kit, Nexium, omeprazole/sodium bicarbonate, Prevacid, Prilosec, Protonix, Zegerid
Rheumatoid Arthritis/Psoriasis (biologic immunomodulators) Actemra subcutaneous, Cimzia, Enbrel, Entyvio, Humira, Humira starter kit, Kineret, Orencia, subcutaneous, Otezla, Simponi, Stelara, Xeljanz

3 Additional categories may be added and the program may change from time to time.

4 Third-party brand names are the property of their respective owners.


More information is available in the step therapy member flier .


If you have questions about the prior authorization/step therapy program, call the number on the back of your BCBSOK ID card.

Mail Service Program

PrimeMail®, the mail service pharmacy for members with BCBSOK prescription drug coverage, provides safe, fast and cost-effective pharmacy services that can save you time and money. With this program, you can obtain up to a 90-day supply of long-term (or maintenance) medications through PrimeMail. Maintenance medications are those drugs you may take on an ongoing basis to treat conditions such as high cholesterol, high blood pressure or diabetes. View the Maintenance Drug List  to see if your medication is included.

Ordering Through PrimeMail

When you log in to Blue Access for Members and visit your Rx Drugs page, you can use the online order form, print an order form to mail or ask that PrimeMail get in touch with your doctor to request a new prescription.

For more information about using mail service:

Glucose Meter Offer

Blue Cross and Blue Shield of Oklahoma offers blood glucose meters to members with diabetes at no additional charge to help you manage your condition. This offer is available through December 31, 2015. See the glucose meter flier  for more information about this offer and monitoring your blood glucose level.

Members with BCBSOK prescription drug coverage should check the Drug List to see which test strips for the meters offered are listed as preferred brands. Coverage and payment levels for test strips may vary depending on your pharmacy benefit plan.

Vaccine Program

If you have coverage through Blue Cross and Blue Shield of Oklahoma, vaccinations may be part of the medical benefit or prescription drug benefit, based on your plan. These vaccines can help protect you from illnesses such as the flu, pneumonia, shingles, rabies, hepatitis B, tetanus, diphtheria and pertussis.

To learn more about which vaccines are available under your plan for you and your covered family members, check your benefit materials for details and any necessary copays. Or, you can call the number on the back of your ID card.

  • For vaccinations covered under the prescription drug benefit, select vaccines can be conveniently administered at a participating vaccine network pharmacy near you.
  • To see a complete list of all participating pharmacies, log in to Blue Access for Members and select Prescription Drugs from the Quick Links section on the right-hand side. Or, you can call the number on the back of your ID card.
  • Before you go, be sure to confirm your selected pharmacy's participation, hours and vaccine availability. Ask about any other age limits, restrictions or requirements that may apply. Remember to present your ID card to the pharmacist.

More information is available in the pharmacy vaccine program member flier .