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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.
1,000MG INJ
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Note TitleNot CoveredDefinitionThis 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.
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Note TitleNot Covered By Blue Cross for Medicare Supplemental membersDefinitionMedicare 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.
4,000MG INJ
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Note TitleNot CoveredDefinitionThis 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.
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Note TitleNot Covered By Blue Cross for Medicare Supplemental membersDefinitionMedicare 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.
5,000MG INJ
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Note TitleNot CoveredDefinitionThis 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.
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Note TitleNot Covered By Blue Cross for Medicare Supplemental membersDefinitionMedicare 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
Medical Benefit Prior Authorization Medication List
Over-the-Counter Exclusion Medication List
Quality Care Dosing Guidelines
Learn About Your Pharmacy Program
Learn About Your Pharmacy Program
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
Medical Benefit Prior Authorization Medication List
No-Cost Generic Medications List
Over-the-Counter Exclusion Medication List
Specialty Pharmacy
Specialty Pharmacy Medication List
5-Tier Specialty Pharmacy Medication List
6-Tier Specialty Pharmacy Medication List