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The preferred alternatives on this list have similar effectiveness, quality and safety, but at a fraction of the cost. 3 0 obj It tel ls you which prescription drugs and over -the -counter drugs and items are covered by Blue Shield Promise Cal MediConnect Plan .
0000003945 00000 n NOTE: This document serves as a quick reference guide.
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Please call Member Service at …
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0000014523 00000 n Our prescription drug benefits can offer potential savings when your physician prescribes medications on the drug list. These drugs may require a doctor’s request for preapproval or prior authorization.Please note: Some employer groups may have specific drug coverage requirements for their employees that are not included in the criteria below.
Inclusion of a drug on the DBL does not mean or imply that the drug is fit or effective for any specific purpose.
0000009547 00000 n 0000001799 00000 n 0000032998 00000 n *Coverage Benefit - (P) Pharmacy Benefit, (M) Medical Benefit, (B) Both Some drugs, such as those used for cosmetic purposes, may be excluded from your benefits. The following guidelines are meant to help members understand the requirements related to their drug coverage. The DBL is not intended to be, and must not be used as a diagnostic or prescribing tool.
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Drug List / Formulary Anthem Blue Cross and Blue Shield’s prescription drug benefits include medications available
Healthy Indiana Plan PLUS Preferred Drug List Effective May 1, 2017 Introduction The Healthy Indiana Plan PLUS Preferred Drug List (PDL) lists medications available under the pharmacy benefit. h���A ���[@'_d@�|F@7���$)>���Csh͡94��L5�sh͡94����Csh͡94����k͡94����Cs���0 r�=� endstream endobj 3697 0 obj <>/Metadata 287 0 R/Pages 282 0 R/StructTreeRoot 289 0 R/Type/Catalog/ViewerPreferences<>>> endobj 3698 0 obj
These maintenance medications, also known as long-term medications, are included in our Smart90®´, Select Home Delivery, and Exclusive Home Delivery programs.
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0000016515 00000 n Not all drugs listed are covered by all prescription drug plans.
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The PDL is 1 Page 3
See the list of Excluded Drugs with available covered options. 0000008420 00000 n
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guarantee of coverage.
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