Pharmacy Services

Effective 9/1/2014, BlueCross Blueshield of  Western New York now has one enhanced pharmacy network where A and B networks have been combined.

Pharmacy Network


Pharmacy Directory

Member Medication Guide
View the Member Formulary (list of covered drugs) to determine the tier for your medication.  

This applies to products offered through large employer groups with more than 50 employees (and small employer groups until their renewal in 2014).

It also applies to Child Health Plus, under which only Tier 1 and Tier 2 drugs are applicable.

Updates to Member Formulary

Check here to see if there are any changes to the Member Medication Guide.  

This applies to products offered through large employer groups with more than 50 employees (and small employer groups until their renewal in 2014).

Exclusive Formulary
View the formulary (list of covered drugs) to determine the tier for your medication. 
This applies to products offered through small employer groups with less than 50 employees and directly to individuals, beginning upon renewal in 2014.

Updates to Exclusive Formulary
Check here to see if there are any changes to the Exclusive Formulary.

Exclusive Formulary, Most Common Medications Affected
View the most common tiering differences between the Member Medication Guide/Formulary and the Exclusive Formulary

Prior Approval Non Formulary Request Form
Check here to view the Prior Approval form.

Express Scripts Basic Formulary
View the 2015 Express Scripts formulary that contains a list of the most commonly prescribed drugs.

Express Scripts National Preferred Formulary with Exclusions
View the 2015 Express Scripts National Preferred Formulary with Exclusions.

If you have any questions regarding your Formulary, please call the number on the back of your card for assistance.

To view our Medicare Prescription Drug Part D information, please visit our 2015 Medicare Resource Center.

If you have any questions regarding your Formulary, please call the number on the back of your card for assistance.

Medicaid and Family Health Plus Formulary
Our list of covered drugs for Medicaid and Family Health Plus members

Updates to Medicaid and Family Health Plus Formulary

NYS Medicaid Prior Authorization Form for Prescriptions

If you have any questions regarding your Formulary, please call the number on the back of your card for assistance.

High Risk Medication List
The Pharmacy Quality Alliance has determined that these high risk medications have the highest risk of side effects for elderly patients

The benefit information provided is a brief summary, not a complete description of benefits.  For more information, contact the plan.  Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.

MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.

Medicare MSA Plans don’t cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate Medicare Prescription Drug Plan.

There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan at 1-800-248-9296 (TTY 711) for additional information.

You must file Form 1040, US Individual Income Tax Return, along with Form 8853, “Archer MSA and Long-Term Care Insurance Contracts” with the Internal Revenue Service (IRS) for any distributions made from your Medicare MSA account to ensure you aren’t taxed on your MSA account withdrawals. You must file these tax forms for any year in which an MSA account withdrawal is made, even if you have no taxable income or other reason for filing a Form 1040. MSA account withdrawals for qualified medical expenses are tax free, while account withdrawals for non-medical expenses are subject to both income tax and a fifty (50) percent tax penalty.”

Tax publications are available on the IRS website at http://www.irs.gov or from 1-800-TAX-FORM (1-800-829-3676). 




BlueCross BlueShield of Western New York is a Medicare Advantage plan with a Medicare contract. Enrollment in BlueCross BlueShield of Western New York depends on contract renewal.

Y0086  H9788_MRK1514 Pending 
Content last updated June 10, 2015