Prescription Drug Lists (aka Formularies)

The Blue Cross and Blue Shield of Nebraska (BCBSNE) Preferred 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 formulary list to determine coverage. In order to do so, you may log in to your myNebraskablue online account and search for covered formulary drugs, or you may contact the Member Services Department at the phone number listed on the back of your BCBSNE member ID card. 

Formulary 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.

Your prescription drug list is specific to the health plan in which you are enrolled. Visit myNebraskablue.com to view the correct list for your plan. If you are not currently enrolled in myNebraskablue.com, please do so!

Standard Preferred Prescription Drug List

NetResults Covered Drug List

  • Download the NetResults covered drug list (formulary)

Generics Plus Preferred Drug List

Some BCBSNE plans offer the Generics Plus formulary. You can visit www.myprime.com to search the online formulary or download it here.

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

List of Covered Drugs on Marketplace Plans

Individual Plans

Small Group Plans

2017 Individual and Small Group Plans

IMPORTANT: These drug lists may be updated at any time without notice. Please be aware that including a medication on a drug list does not ensure coverage. Please use this form if requesting a medication that is not covered under plan. Not all medications are covered based on coverage guidelines provided in your member contract or per federal or state regulation. 

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, Blue Cross and Blue Shield of Nebraska 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 January 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.