Pharmacy Services

Pharmacy B Network
(if pharmacy B is listed on the back of your ID card)

Pharmacy A Network
(all other members)

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 2014 Express Scripts formulary that contains a list of the most commonly prescribed drugs.

Express Scripts National Preferred Formulary with Exclusions
View the 2014 Express Scripts National Preferred Formulary with Exclusions.


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

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.

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_MRK1284 Approved
Content last updated October 1, 2013