Drug Formulary

The Blue Cross and Blue Shield of Nebraska (BCBSNE) drug formulary is a list of drugs that are covered under our plans. Formulary drugs are medications recommended by the Blue Cross and Blue Shield of Nebraska Pharmacy and Therapeutics Committee. These drugs are selected based on a quality evaluation of safety, effectiveness, unique qualities and cost.

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

PDL 10 (Formerly BCBSNE Standard Formulary)


PDL 30 (Formerly NetResults 2 Formulary)


PDL 98 (Formerly BCBSNE Generics Plus Formulary)  


PDL 99 (Formerly BCBSNE Small Group 4-Tier Prescription Drug List)

PDL 60 (Formerly BCBSNE 6-Tier Prescription Drug List)

  • Search the prescription drug list (Make sure your plan and prescription drug list is selected)
  • Download the prescription drug list for individual and small group plans renewing on or after 01/01/17 (pdf)
  • Please use this form (pdf) if requesting a medication that is not covered under your plan. Not all medications are covered based on coverage guidelines provided in your member contract or per federal or state regulation.


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 by using this form (pdf). Not all medications are covered based on coverage guidelines provided in regulation and member contracts.


Oral Oncology Medications

Benefits for orally administered cancer drugs have changed for some benefit plans. View a list of oral oncology medications. (pdf)



The percentage of the bill you pay after your deductible has been met.


A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 


The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.


Includes behavioral health treatment, counseling, and psychotherapy

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)


Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.


If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.


The amount you pay to your health insurance company each month. 

Preventive services

Health care services that focus on the prevention of disease and health maintenance.


Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.