The drugs on the Premium formulary have been selected for their clinical effectiveness, safety, and maximized savings. The Premium formulary maintains affordable medication access and promotes the use of lower-cost alternatives for members of self-funded groups.
The Premium formulary differs from the Select Drug Program formulary in that it excludes 80 medications, which all have clinical alternatives included in the Premium formulary.
Effective use of the formulary
Help your Independence Blue Cross (Independence) patients make the most of their health care dollars. Before prescribing a medication to an Independence member that has the Premium Formulary, please consider whether the drug is included or if a generic equivalent or similar drug is available.
The Premium formulary is managed and maintained by an independent pharmacy benefits management (PBM) company.¹ — Independence does not control how the Premium formulary is comprised or administered.
- Premium formulary guide
- Latest formulary changes
- Premium formulary utilization management updates
- Procedures that support safe subscribing
- Premium formulary exclusion list
- Premium formulary prior authorization list
- Premium formulary step therapy list
- Premium formulary quantity limit list
- HDHP preventive drug list
- HCR preventive drug list
- HCR preventive $0 HIV PrEP
Premium Formulary Drug Look Up Tool
Frequently Asked Questions
- Medications may be considered for exclusion if they are deemed therapeutically equivalent or in the same class as a clinically similar product on the formulary.
- Products must undergo a rigorous clinical and financial evaluation process before they can be included or excluded.
- As new clinical information is introduced, prices shift, or other dynamics change, included or excluded medications may be re-evaluated for coverage.
- Clients and members utilizing drugs that are changing will be notified of updates to the list of excluded drugs and drugs that change tiers prior to January 1 and July 1, at which times formulary updates take place.
- Online at ibx.com: Members can search for medications and confirm coverage.
- Member Services: Customer Service representatives are available to educate members about their pharmacy benefit. Members should call the phone number on the back of their ID cards.
- Notification letters: When applicable, we notify members before a medication is excluded and inform them of covered alternatives to discuss with their physicians.
- Formulary updates: When applicable, we notify members before a medication switches to a higher cost-sharing tier.
¹ Independence Blue Cross’ prescription drug plans are administered by an independent pharmacy benefits management company.