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Medication Lookup

The results below have been sorted using a 2-tier plan. For the most accurate search results, check your plan details and choose another tier plan from the drop-down menu near the search bar.

JIVI
THERAPEUTIC CLASS: Antihemophilic Products
Select a strength to see details

500U VIAL

500U VIAL
Not Covered by a 3-Tier Plan
Learn more about tiers.
  • Note Title
    Preferred Provider
    Definition
    This medication is not covered through the pharmacy benefit. It is covered under your home infusion benefit, which is part of your medical coverage. Caremark is the preferred home infusion therapy provider for this medication. You can call them at 1-800-237-2767.
  • Note Title
    Not Covered
    Definition
    This medication is excluded from the pharmacy benefit. It is covered by the medical benefit. Please talk to your doctor about alternatives or other covered options.
  • Note Title
    Prior Authorization Required
    Definition
    This medication requires your doctor to obtain prior authorization from us in order to be covered through the medical benefit.
  • Note Title
    Not Covered By Blue Cross for Medicare Supplemental members
    Definition
    Medicare Supplemental Plan Members: Since this medication is covered by Medicare as a medical benefit, it is excluded from your pharmacy coverage. You will need to verify coverage from Medicare directly.

1000U VIAL

1000U VIAL
Not Covered by a 3-Tier Plan
Learn more about tiers.
  • Note Title
    Preferred Provider
    Definition
    This medication is not covered through the pharmacy benefit. It is covered under your home infusion benefit, which is part of your medical coverage. Caremark is the preferred home infusion therapy provider for this medication. You can call them at 1-800-237-2767.
  • Note Title
    Not Covered
    Definition
    This medication is excluded from the pharmacy benefit. It is covered by the medical benefit. Please talk to your doctor about alternatives or other covered options.
  • Note Title
    Prior Authorization Required
    Definition
    This medication requires your doctor to obtain prior authorization from us in order to be covered through the medical benefit.
  • Note Title
    Not Covered By Blue Cross for Medicare Supplemental members
    Definition
    Medicare Supplemental Plan Members: Since this medication is covered by Medicare as a medical benefit, it is excluded from your pharmacy coverage. You will need to verify coverage from Medicare directly.

2000U VIAL

2000U VIAL
Not Covered by a 3-Tier Plan
Learn more about tiers.
  • Note Title
    Preferred Provider
    Definition
    This medication is not covered through the pharmacy benefit. It is covered under your home infusion benefit, which is part of your medical coverage. Caremark is the preferred home infusion therapy provider for this medication. You can call them at 1-800-237-2767.
  • Note Title
    Not Covered
    Definition
    This medication is excluded from the pharmacy benefit. It is covered by the medical benefit. Please talk to your doctor about alternatives or other covered options.
  • Note Title
    Prior Authorization Required
    Definition
    This medication requires your doctor to obtain prior authorization from us in order to be covered through the medical benefit.
  • Note Title
    Not Covered By Blue Cross for Medicare Supplemental members
    Definition
    Medicare Supplemental Plan Members: Since this medication is covered by Medicare as a medical benefit, it is excluded from your pharmacy coverage. You will need to verify coverage from Medicare directly.

3000U VIAL

3000U VIAL
Not Covered by a 3-Tier Plan
Learn more about tiers.
  • Note Title
    Preferred Provider
    Definition
    This medication is not covered through the pharmacy benefit. It is covered under your home infusion benefit, which is part of your medical coverage. Caremark is the preferred home infusion therapy provider for this medication. You can call them at 1-800-237-2767.
  • Note Title
    Not Covered
    Definition
    This medication is excluded from the pharmacy benefit. It is covered by the medical benefit. Please talk to your doctor about alternatives or other covered options.
  • Note Title
    Prior Authorization Required
    Definition
    This medication requires your doctor to obtain prior authorization from us in order to be covered through the medical benefit.
  • Note Title
    Not Covered By Blue Cross for Medicare Supplemental members
    Definition
    Medicare Supplemental Plan Members: Since this medication is covered by Medicare as a medical benefit, it is excluded from your pharmacy coverage. You will need to verify coverage from Medicare directly.

 Prior Authorization Forms

Massachusetts Standard Form for Hepatitis-C Medication Prior Authorization Requests

Massachusetts Standard Form for Medication Prior Authorization Requests

Massachusetts Standard Form for Synagis® Medication Prior Authorization Requests

 Important Information

Affordable Care Act (ACA) Medication List

Maintenance Medication List

Medical Benefit Prior Authorization Medication List

Over-the-Counter Exclusion Medication List

Quality Care Dosing Guidelines

Step Therapy Medication List

Learn About Your Pharmacy Program

Learn About Tiers

Learn About Your Pharmacy Program

$0 Copay Medication List

Affordable Care Act (ACA) Medication List

Cost-Share Assistance Program Medication List

Health Savings Account (HSA) Preventive Medication List

Lower-Cost, Brand-Name Insulins Medication List

Maintenance Medication List

Medical Benefit Prior Authorization Medication List

No-Cost Generic Medications List

Over-the-Counter Exclusion Medication List

Quality Care Dosing Guidelines

Step Therapy Medication List

 Specialty Pharmacy

Specialty Pharmacy Medication List

5-Tier Specialty Pharmacy Medication List

6-Tier Specialty Pharmacy Medication List

Specialty Network Pharmacy Contact Information

Specialty Network Pharmacy Contact Information

 Alternatives to Opioids

Covered Pain Management Medication List

Alternatives to Opioid-Based Medications

 For Federal Employee Program Members

Visit fepblue.org to search the formularies

 Eligible Medicare Members

Search a Medicare Formulary

Covered Alternative Medications