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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.
80MG/0.8ML AUTOINJECTOR
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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.
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitleQuality Care DosingDefinitionTo ensure safety and effectiveness, this medication, which is covered through the pharmacy benefit, has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). Review the Quality Care Dosing Guidelines in the Important Information section to learn more.
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Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
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Note TitleExceptions To Non Covered MedicationsDefinitionYour doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
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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.
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitleQuality Care DosingDefinitionTo ensure safety and effectiveness, this medication, which is covered through the pharmacy benefit, has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). Review the Quality Care Dosing Guidelines in the Important Information section to learn more.
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Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
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Note TitleExceptions To Non Covered MedicationsDefinitionYour doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
80MG/0.8ML - 40MG/0.4ML PREFILLED SYRINGE KIT
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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.
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitleQuality Care DosingDefinitionTo ensure safety and effectiveness, this medication, which is covered through the pharmacy benefit, has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). Review the Quality Care Dosing Guidelines in the Important Information section to learn more.
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Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
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Note TitleExceptions To Non Covered MedicationsDefinitionYour doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
20MG/0.2ML PREFILLED SYRINGE
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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.
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
-
Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitleQuality Care DosingDefinitionTo ensure safety and effectiveness, this medication, which is covered through the pharmacy benefit, has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). Review the Quality Care Dosing Guidelines in the Important Information section to learn more.
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Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
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Note TitleExceptions To Non Covered MedicationsDefinitionYour doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
10MG/0.1ML PREFILLED SYRINGE
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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.
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitleQuality Care DosingDefinitionTo ensure safety and effectiveness, this medication, which is covered through the pharmacy benefit, has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). Review the Quality Care Dosing Guidelines in the Important Information section to learn more.
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Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
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Note TitleExceptions To Non Covered MedicationsDefinitionYour doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
80MG/0.8ML-40MG/0.4ML AUTOINJECTOR KIT
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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.
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitleQuality Care DosingDefinitionTo ensure safety and effectiveness, this medication, which is covered through the pharmacy benefit, has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). Review the Quality Care Dosing Guidelines in the Important Information section to learn more.
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Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
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Note TitleExceptions To Non Covered MedicationsDefinitionYour doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
40MG/0.4ML PREFILLED SYRINGE
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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.
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
-
Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
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Note TitleQuality Care DosingDefinitionTo ensure safety and effectiveness, this medication, which is covered through the pharmacy benefit, has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). Review the Quality Care Dosing Guidelines in the Important Information section to learn more.
-
Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
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Note TitleExceptions To Non Covered MedicationsDefinitionYour doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
40MG/0.4ML AUTOINJECTOR
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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.
-
Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
-
Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
-
Note TitleQuality Care DosingDefinitionTo ensure safety and effectiveness, this medication, which is covered through the pharmacy benefit, has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). Review the Quality Care Dosing Guidelines in the Important Information section to learn more.
-
Note TitleRequires Specialty PharmacyDefinitionThis medication will only be covered through the pharmacy benefit when purchased through a specialty pharmacy that participates in our network. To find a specialty pharmacy, visit Specialty Network Pharmacy Contact Information in the Specialty Pharmacy section.
-
Note TitleExceptions To Non Covered MedicationsDefinitionYour doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
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