Prescription Drug Lists
A prescription drug list, also called a formulary, is a list of drugs included with most plans prescription drug benefits and coverage of these drugs is subject to your benefit plan's design. Please review your prescription drug plan along with the prescription drug list to determine coverage. Prescription drugs are medications recommended by our Pharmacy and Therapeutics Committee. These drugs are selected based on a quality evaluation of safety, effectiveness, unique qualities and cost to ensure you are receiving the best care you possibly can.
Your prescription drug list is specific to the health plan in which you are enrolled. You can manage your medicines and view your correct prescription drug list online. Login to myNebraskaBlue.com.
The prescription drug lists may be updated at any time without notice. Please be aware that a medication listed on a prescription drug list does not ensure coverage.
You can also view the prescription drug lists (PDL) as a guest on MyPrime or by downloading list below. Be sure to select the correct plan. Contact Member Services at the phone number listed on the back of your member ID card if you do not know in which plan you are enrolled.
Search the prescription drug list on MyPrime.com
Formerly "BCBSNE Standard Formulary"
July 2024 Prescription Drug List (PDL 10)
Updates to PDL 10 - July 2024
Preventive Drug List for PDL 10
PDL 20
July 2024 Prescription Drug List (PDL 20)
Updates to PDL 20 - July 2024
Alternatives for PDL 20
Preventive Drug List for PDL 20, 30 and 40
Formerly "NetResults 2 Formulary"
July 2024 Prescription Drug List (PDL 30)
Updates to PDL 30 - July 2024
Alternatives for PDL 30
Preventive Drug List for PDL 20, 30 and 40
PDL 40
July 2024 Prescription Drug List (PDL 40)
Updates to PDL 40 - July 2024
Alternatives for PDL 40
Preventive Drug List for PDL 20, 30 and 40
PDL 66
Prescription Drug List 66 (BluePride renewals starting 04/01/2024 and after)
PDL 68
Prescription Drug List 68 (Individual 6-Tier PDL for 07/01/24)
PDL 69
Prescription Drug List 69 (Individual 4-Tier PDL for 07/01/24)
PDL 90
Prescription Drug List 90 (BluePride renewals 01/01/24 and after)
Prescription Drugs Requiring Preauthorization
As part of our efforts to address the serious issue of escalating costs and continue to provide you with access to quality and cost-effective pharmacy care, BCBSNE requires that benefits for certain drugs be preauthorized. Please view the Medications Requiring Preauthorization. Your doctor will need to complete the applicable preauthorization form.
Oral Oncology Medications
Oral oncology medications filled through an in-network specialty pharmacy may be covered at no cost to you. View the list of Orally Administered Cancer Medications.
Two-Tier Generic Drug List
A two-tiered generic medications benefit design features a generic drug list with two levels of member cost-share amounts for generic prescription medications. This design provides an incentive for you to request lower-cost generic medications from your health care provider whenever possible. View the Two-Tier Generic Drugs.