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Pharmacy Management

Access forms and resources online so you can get the information you need. For Medicare Advantage please see the policies and procedures or call 855-457-1351 »

The drug formulary is a list of drugs that are included in most BCBSNE prescription drug plans. Coverage of these drugs is subject to the member's prescription benefit plan design. Download each prescription drug list (PDL) below:

You can also search the prescription drug lists on  MyPrime.com

Outpatient Drug Exclusions

In addition, certain prescription drugs and covered services administered in an outpatient setting are only available under a BCBSNE prescription drug plan.

To verify benefits, please call Customer Services at 800-635-0579.
Download the Outpatient Drug Exclusions List

Important: Formularies may be updated at any time without notice. Please be aware that including a medication on a formulary does not ensure coverage.

Oral Oncology Medications

Oral oncology medications obtained through an in-network specialty pharmacy may be covered at no cost to the member. 
View the list of these medications. 

Formulary Review Requests (Non-Medicare Only)

Physicians and other health care professionals may ask for a product to be added to the formulary. Please provide clinical studies, safety data, unique qualities, etc. to support your recommendation. Also, please let us know if the formulary review was requested by a pharmaceutical representative. Send your request to:

Blue Cross and Blue Shield of Nebraska
Attn: Pharmacy Director
1919 Aksarben Drive
P.O. Box 3248
Omaha, NE 68180-0001
Formulary Exception Review Requests (Qualified Health Plans Only)

Physicians and other health care professionals may ask for coverage of an Essential Health Benefit medication not covered on the formulary. Not all medications are covered based on coverage guidelines provided in regulation and member contracts.
Download the Formulary Exception Form (Qualified Health Plans Only)

Formulary Exception Review Requests (PDL 20 and 30)

Physicians and other health care professionals may ask for coverage of a medication not covered on the formulary.
Download the Formulary Exception Form (PDL 20 and 30 Only)

Pharmacy Preauthorization

Please refer to the  Drugs Requiring Preauthorization list for our standard list of medications requiring preauthorization.  Additional medications may require preauthorization per individual contract. You may also refer to our  Outpatient Drug Exclusions List for members. If you are unable to submit a pharmacy preauthorization online through NaviNet, you can print the form. See all pharmacy preauthorizations forms.

Submit a Pharmacy Pre-Authorization Online »

Please use the appropriate ICD-10 codes.