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"
Prescription Drug List 10 (PDL 10)
Preventive Drug List for PDL 10
PDL 20
Prescription Drug List 20 (PDL 20)
Formulary Alternatives for PDL 20
Preventive Drug List for PDL 20, 30 and 40
Formerly "NetResults 2 Formulary"
Prescription Drug List 30 (PDL 30)
Formulary Alternatives for PDL 30
Preventive Drug List for PDL 20, 30 and 40
PDL 40
Prescription Drug List 40 (PDL 40)
Formulary Alternatives for PDL 40
Preventive Drug List for PDL 20, 30 and 40
PDL 63
Prescription Drug List 63 (for renewals starting 1/1/20 and after)
PDL 64
Prescription Drug List 64 (for renewals starting 1/1/21 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.