- Quantity Management – This program limits the amount we cover for certain drugs. We provide medical necessity exceptions for some of these limits when you request and receive prior authorization for them.
- Step Therapy – Step therapy requires members to try cost-effective “First Choice” medications before trying (or “stepping up to”) more expensive “Second Choice” medications. We provide medical necessity exceptions when you request and receive prior authorization for them.
- Lowest Net Cost Formulary – Applies to most of our benefit plans, with just a few exceptions.
- Specialty Pharmacy Drug List – Features drugs that are used to treat complex or chronic medical conditions.
- Excluded Drug List – Shows drugs that are excluded from coverage, as well as how to request a formulary exception.
- Prior Authorization Drug List – Applies to prescription drugs that require prior authorization.
- Medical Drug List – This list applies to specialty medical drugs that require prior authorization through the MBMNow portal on My Insurance Manager.
A member's specific health plan determines which drug lists apply to them. Members who are not sure which drug lists apply to their plans can log into My Health Toolkit® for personal information.