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
• HSA Preventive Drug List

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

• ACA Preventive Drug List
• Preferred Drug List (formulary)
• Quantity Limit Guidelines and Forms
• Formulary Exception Process
• Prior Authorization Guidelines and Forms
• Step Therapy Guidelines and Forms
• Summary of Most Recent Formulary Changes

4 Tier Net Results Plus

• 4-Tier Results Plus Prescription Drug List (formulary)
• ACA Preventive Drug List
• Quantity Limit Guidelines and Forms
• Formulary Exception Process
• Prior Authorization Guidelines and Forms
• Step Therapy Guidelines and Forms
• Summary of Most Recent Formulary Changes

5 Tier Specialty

• 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

• 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

• 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

• 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

Medicare Advantage Formulary

This information applies to Medicare Advantage members only and includes formularies for our individual and group plans.

2021

• Comprehensive Medicare Advantage Formulary - Individual
• Comprehensive Medicare Advantage Formulary - Group
• Quantity Limits
  • Medicare Advantage Quantity Limits - Individual
  • Medicare Advantage Quantity Limits - Group
  • Healthmate for Medicare Quantity Limits - Individual
  • Healthmate for Medicare Quantity Limits - Group
• Step Therapy Criteria
  • Medicare Advantage Step Therapy Criteria - Individual
  • Medicare Advantage Step Therapy Criteria - Group
  • Healthmate for Medicare Step Therapy Criteria - Individual
  • Healthmate for Medicare Step Therapy Criteria - Group
• Prior Authorization Criteria
  • Medicare Advantage Prior Authorization Criteria - Individual
  • Medicare Advantage Prior Authorization Criteria - Group
  • Healthmate for Medicare Prior Authorization - Individual
  • Healthmate for Medicare Prior Authorization - Group
• Medicare Part D Coverage Determination Request Form
• Medicare Part D Redetermination Request Form
• Preferred Retail Pharmacy Listing

Helpful Documents

• CoverMyMeds Quick Reference Guide
• CoverMyMeds Automated Prior Authorization
• MDR Letter Template - Medicare Segment