Find formularies and other pharmacy information
Find all the information you need to manage your patients’ prescription drugs, including formularies, prior authorization forms, drug quantity limits, and more.
Commercial Formulary
This information applies to members of all Blue Cross & Blue Shield of Rhode Island plans except BlueCHiP for Medicare.
General Documents
- Summary of Most Recent Formulary Changes
- Walgreens Universal Intake Referral Form
- Pharmaceutical Management Procedures
CoverMyMeds
If you know the name of a drug a member is taking and want to find out if any restrictions apply (for example, quantity limits or prior authorization), you can look up the drug on covermymeds.com.
4 Tier
- 2018 Preferred Drug List (formulary)
- 2019 Preferred Drug List (formulary)
- Quantity Limit Guidelines and Forms
- Formulary Exception Process
- Prior Authorization Guidelines and Forms
- Step Therapy Guidelines and Forms
5 Tier Specialty
- 2018 Preferred Drug List (formulary)
- 2019 Preferred Drug List (formulary)
- Quantity Limit Guidelines and Forms
- Formulary Exception Process
- Prior Authorization Guidelines and Forms
- Step Therapy Guidelines and Forms
6 Tier Flex
- 2018 Preferred Drug List (formulary)
- 2019 Preferred Drug List (formulary)
- Quantity Limit Guidelines and Forms
- Formulary Exception Process
- Prior Authorization Guidelines and Forms
- Step Therapy Guidelines and Forms
5 Tier Generic
- 2018 Preferred Drug List (formulary)
- 2019 Preferred Drug List (formulary)
- Quantity Limit Guidelines and Forms
- Formulary Exception Process
- Prior Authorization Guidelines and Forms
- Step Therapy Guidelines and Forms
5 Tier Direct
- 2019 Preferred Drug List (formulary)
- Quantity Limit Guidelines and Forms
- Formulary Exception Process
- Prior Authorization Guidelines and Forms
- Step Therapy Guidelines and Forms
Traditional
- Preferred Drug List (formulary)
- Quantity Limit Guidelines and Forms
- Formulary Exception Process
- Prior Authorization Guidelines and Forms
- Step Therapy Guidelines and Forms
BlueCHiP for Medicare Formulary
This information applies to BlueCHiP for Medicare members only and includes formularies for our individual and group plans.
2019
- 2019 Comprehensive BlueCHiP for Medicare Formulary-Individual
- 2019 Comprehensive BlueCHiP for Medicare Formulary-Group
- 2019 BlueCHiP for Medicare Quantity Limits- Individual
- 2019 BlueCHiP for Medicare Quantity Limits- Group
- 2019 BlueCHiP for Medicare Step Therapy Criteria- Individual
- 2019 BlueCHiP for Medicare Step Therapy Criteria - Group
- 2019 BlueCHiP for Medicare Prior Authorization Criteria- Individual
- 2019 BlueCHiP for Medicare Prior Authorization Criteria- Group
- Medicare Part D Coverage Determination Request Form
- Medicare Part D Redetermination Request Form
- Preferred Retail Pharmacy Listing
2018
- 2018 Comprehensive Member Formulary - Individual Plan (Value)
- 2018 Comprehensive Member Formulary - Individual Plan (Advance, Standard with Drugs, Extra, Plus, Preferred)
- 2018 BlueCHiP for Medicare Formulary – Group Plan
- 2018 BlueCHiP for Medicare Quantity Limits - Individual Plans
- 2018 BlueCHiP for Medicare Quantity Limits - Group Plans
- 2018 Step Therapy Criteria - Individual Plans
- 2018 Step Therapy Criteria - Group Plans
- Medicare Part D Coverage Determination Request Form
- Medicare Part D Redetermination Request Form
- Preferred Retail Pharmacies
Prior Authorization
2018
- Download 2018 Individual Prior Authorization Criteria forms
- Download 2018 Group Prior Authorization Criteria forms