Prescription Drug Lists (aka Formularies)

The Blue Cross and Blue Shield of Nebraska (BCBSNE) Prescription Drug List, also called a formulary, is a list of drugs included in most prescription drug benefits. Coverage of these drugs is subject to your prescription benefit plan design. Please review your prescription drug plan along with the prescription drug list to determine coverage.

Your prescription drug list is specific to the health plan in which you are enrolled. Log in to manage your medicines and view the correct list for your plan. If you are not currently enrolled in myNebraskablue.com, register today! 

IMPORTANT: The prescription drug lists may be updated at any time without notice. Please be aware that including a medication on a prescription drug list does not ensure coverage.

Prescription drugs are medications recommended by the BCBSNE Pharmacy and Therapeutics Committee. These drugs are selected based on a quality evaluation of safety, effectiveness, unique qualities and cost.

You may contact the Member Services Department at the phone number listed on the back of your BCBSNE member ID card if you do not know in which plan you are enrolled.

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")

You're covered - benefits for epinephrine, effective July 1, 2017

Effective July 1, 2017, benefits for EpiPen®, EpiPen Jr®, Adrenaclick® and the authorized generic of Adrenaclick have changed. BCBSNE member benefits are available under all plans for the authorized generic of EpiPen and EpiPen Jr.

According to the FDA, an authorized generic is the exact same drug as the brand name version. The only difference is the name on the label. The price of the authorized generic is significantly lower than the price of the brand. 

Your doctor must write a new prescription for the authorized generic version of EpiPen or EpiPen Jr. Please talk to your doctor as soon as possible. 

You know only too well how expensive prescription drugs can be. We continually evaluate the health benefits of medications to promote quality, cost-effective pharmacy care to keep your health care safe and affordable. This change to your benefits is part of that ongoing effort.

If you have any questions about your prescription drug coverage, please call our Member Services Department at the number on the back of your member ID card. For information about your plan’s drug list, in-network pharmacies and prescription history, utilize the Pharmacy Benefits tool located within myNebraskablue.com.

If you know the name of your formulary, you can review it using the appropriate link at the top of this page.

We appreciate the opportunity to provide your prescription drug coverage and look forward to continuing to serve you in the future.

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 list of those medications or search all medical policies at Med Policy Blue. Your health care provider will need to complete the applicable preauthorization form and fax or mail it to us.  

Oral Oncology Medications

Beginning October 1, 2012, benefits for orally administered cancer drugs will change for some benefit plans. A listing of these oral oncology medications can be found here.

Two-Tier Generic Drug List

Beginning Jan. 1, 2017, a two-tiered generic medication benefit will be in effect, which could affect how much you pay for certain generic drugs. 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. A complete list of these medications can be found here.

HEALTH INSURANCE TERMS


COINSURANCE

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

COPAY

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. 

DEDUCTIBLE

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.

SUBSTANCE ABUSE DISORDER SERVICES

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.)

out-of-pocket

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

penalty

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.

premium

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.

rehab SERVICES

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).

specialist

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.