Drug Coverage

Blue Cross Community MMAI (Medicare-Medicaid Plan)SM includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. The Drug List (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. This list includes generic and brand drugs and medical supplies. It also includes the drugs covered by Medicare Part D.

To see your plan's Drug List, go to Forms & Documents.

As a member, you have no co-pay for covered item on the Drug List. Please see Drug Information section below for more information. Your plan covers the items in the Drug List as long as you:

  • Have a medical need for them
  • Have a prescription from your doctor for them
  • Fill the prescription at a network pharmacy
  • Follow the plan rules

Personal Health-Related Items

Personal health-related items (such as a toothbrush and toothpaste) are not included on this list. However, you can order these items once every three months.

The plan will pay up to $30 (plus $5 for shipping) for each order. If you do not use the $30, it does not roll over into the next three months. You can get one shipment every three months.

To see if you are eligible, Contact: Blue Cross and Blue Shield of Illinois' OTC vendor, Convey Health Solutions, at: 1-855-891-5274. See Chapter 4 of the Member Handbook for more details.

Prior Authorization

Certain drugs on the list need prior authorization. Your doctor will need to request approval before these drugs can be prescribed. Without approval, the drug won't be covered.

Talk with your doctor about your medication. Your doctor will choose which drug is best for you. If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug.

For some drugs, the plan limits the amount that will be covered. You can find out if your drug has any added conditions or limits by looking at the Drug List.

To protect your health and keep you safe, make sure your doctor and pharmacist know what medicines you are taking, including OTC drugs.

MyPrime.com is a pharmacy benefit website owned and operated by Prime Therapeutics LLC, a separate company providing pharmacy benefit management services for your plan.

†Convey Health Solutions, Inc.

Convey Health Solutions, Inc. is an independent company that provides administrative services for over the counter supplemental benefits for Blue Cross and Blue Shield of Illinois.