Blue Rx Value^SM

Welcome

We cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. Members may be required to pay more for a prescription when a brand-name product is dispensed.

What is a Drug List?

A formulary drug list is a list of drugs covered under your pharmacy benefit and developed to serve as a guide for physicians, pharmacists, healthcare professionals and members in the selection of cost-effective drug therapy. The formulary does not define benefit coverage and limitations. Many members have specific benefit inclusions, exclusions, copayments or a lack of coverage, which are not reflected in the formulary. Members should contact their Plan Sponsor or Wellmark Customer Service at the number on the back of their ID card if they have questions regarding their coverage.

	Tier Designation
	Tier 1	Tier 2
Blue Rx Value 2 Tier	Tier 1	Tier 2
Blue Rx Value 1 Tier	Tier 1 and Tier 2 combined

Printable Files

To view a version of your Formulary Drug List with a screen reader, please click Printable Formulary below.

The following files require Adobe Acrobat. Download Adobe Acrobat

• Printable Formulary
• Prior Authorization

How to Search For Drugs

• Use the alphabetical list to search by the first letter of your medication.
• Search by typing part of the generic and brand names.
• Search by selecting the therapeutic class or category of the medication you are looking for.

Formulary Exception Process

Drugs not included in this list shall be considered non-formulary and are NOT COVERED. In some instances, Wellmark will consider coverage exceptions. Coverage of non-formulary drugs may be requested by the health professional through an exception request for a non-formulary prescription drug. Generally, the following guidelines must be documented in order for an exception to be granted:

• All covered formulary drugs on any tier will be ineffective; OR
• All covered formulary drugs on any tier have been ineffective; OR
• All covered formulary drugs on any tier would not be as effective as the non-formulary drug; OR
• All covered formulary drugs would have adverse effects

Common Drug Exclusions

Due to benefit design parameters, some plan sponsors may choose to exclude certain drug classes. Prior authorization is generally not available for drugs that are specifically excluded by benefit design. Common excluded drugs may include, but are not limited to:

• OTC drugs or their equivalents unless otherwise specified in the formulary listing.
• Drug products used for cosmetic purposes
• Experimental drug products, or any drug product used in an experimental manner
• Replacement of a lost or stolen drug
• Foreign drugs or drugs not approved by the United States Food & Drug Administration (FDA)

Notice of Nondiscrimination

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