Pharmacy – Formulary Focused on Safety and Low Net Cost

Policy Number: GP-PI-004

Last Updated: May 3, 2022 

Benefit designs are complemented by the use of the Blue Cross and Blue Shield of Nebraska (BCBSNE) formulary which provides members with broad access to safe, medically necessary products. The formulary is a list of medications that represent the current clinical judgment of physicians and other experts in the health care arena.  

The Prime Pharmacy and Therapeutics Committee, comprised of actively practicing, independent physicians and pharmacists, make formulary decisions driven by four criteria considered in this order:  

  • Safety
  • Efficacy
  • Unique properties of the drug
  • Lastly, and if necessary, net cost

Nebraska providers are represented on the Prime Pharmacy and Therapeutics Committee. In addition to that representation, BCBSNE utilizes a local Formulary Business Committee to review decisions made by Prime’s committee. The use of formulary agents and generic products enhance our members’ pharmacy benefit.