Pharmacy Information

• Prescription Claim Form [pdf]
• Prescription Mail Service Order Form [pdf]
  If your policy has a mail-order drug benefit, use this form to order new and/or refill mail service prescriptions.

Individual & family drug lists

• Step Therapy Clinical Documentation
• 2024 Metallic 5 Tier Formulary
• 2024 Metallic 6 Tier Formulary
• 2025 Metallic 5 Tier Formulary
• 2025 Metallic 6 Tier Formulary

Understanding your pharmacy coverage

• Using your pharmacy benefits
  How to use your benefits and the advantages your pharmacy plan offers you.
• View pharmacy claims in Blueprint Portal
  Your prescription claims history, including prescription number, date filled, prescriber, quantity, pharmacy, amount paid by you and amount paid by your pharmacy plan. To access information about your personal pharmacy claims, you must register to use Blueprint Portal, our member self-service center.
• Drug pricing
• Save money on medications
• How to read labels
• Generic medications
• Specialty drugs
• Free immunizations at pharmacy

Additional Resources

• 90-day prescription supply
• Rx delivery by mail
• Check your medication cost
• Pharmacy digital tools