As of 2015, the Blue Cross formulary is a list of drugs that each health care plan covers, according to Anthem Blue Cross and Blue Shield. Different plans have different lists. Blue Cross typically prints the formulary on the identification cards of individual, family or small group plan members. Plan participants with employer coverage can obtain the information from their employers or contact Blue Cross customer support. Formularies are available on Blue Cross websites.
To create the formulary, an independent committee of health care professionals, including practicing physicians and pharmacists, periodically reviews new and existing FDA-approved drugs, explains Anthem Blue Cross and Blue Shield. The committee considers drug effectiveness, safety and patient value when deciding which drugs to place on the formulary. The group chooses certain drugs for specific conditions, such as diabetes and asthma.
There are different formularies for various drug categories, such as generic premium drugs, preventive prescription drugs, preferred drugs and specialty drugs, states Anthem Blue Cross and Blue Shield. Blue Cross covers specialty drugs when plan participants' benefits include specialty pharmacy networks and participating specialty pharmacies fill the prescriptions. Blue Cross typically does not cover drugs that are not on the formularies. Patients with prescriptions for non-formulary drugs can complete online forms to request exceptions or ask their doctors to submit the forms to avoid paying out of pocket.