Drug Formulary

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. 

View the Prescription Drug List »

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.
Download the Outpatient Drug Exclusions List (pdf; 58KB)

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

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 (pdf; 94KB)


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. 



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.