Woman putting medicine in a pill box.

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)

Formerly "BCBSNE 6-Tier Prescription Drug List"

Prescription Drug List 62 (PDL 62)

PDL 63

Prescription Drug List 63 (for renewals starting 1/1/20 and after)

Preventive PDL

The following list of prescription medications, over-the-counter medications and supplies may be covered under your plan as part of the Affordable Care Act (ACA). Benefits for the items listed here are covered at no cost to you when they are obtained from a Blue Cross and Blue Shield of Nebraska network pharmacy provider, subject to the gender, age and frequency limits indicated, not to exceed the plan’s retail or mail order day supply limit.

Preventive Prescription Drug List

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.