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What if your drug is not in the formulary?

If your prescription drug is not listed in the formulary, first call Customer Service to verify it is truly not covered. You can reach us at 1-888-494-2583, we are available from 8 a.m. to 8 p.m. seven days a week. TTY users can call 1-800-377-1363.

Within the first 90 days of joining our plan you may request a one-time fill of a non-formulary drug. After your one-time fill we will send you a list of covered formulary drugs commonly used to treat your medical condition. You can ask your provider if any of the drugs on this list are an option for your treatment. You can also request a formulary exception (which is a type of coverage determination).

If Customer Service confirms that we do not cover your drug, you have three options:

  • Ask your provider if you can switch to another drug that the plan covers. Call Customer Service if you need a list of covered drugs to share with your provider.
  • Ask us to make an exception (which is a type of coverage determination) and cover your drug using the Prescription Drug Coverage Determination form.

Return this form using one of the following:

Mail: Blue Cross of Idaho, PO Box 8406, Boise ID 83707
Fax: 208-381-8829

  • You can pay for the drug and ask us to reimburse you by making an exception request (which is a type of coverage determination). An exception request does not obligate us to reimburse you if the request is not approved. If your request is not approved, you have the right to appeal the denial using the Prescription Drug Coverage Redetermination form. Return this via fax or mail using the information shown on the form.

    Y0010_MK 13121 Approved 12-31-2012
    Last updated 11-14-2012