Drug Lists

• Medical Drug List – This list applies to specialty medical drugs that require prior authorization through the MBMNow portal on My Insurance Manager.
• Optional Drug List – The drugs on this list are specialty products that are not covered for most members unless specifically elected by their employer group. 
• Self-Administration Drug List – The drugs on this list are usually not covered under the medical benefit, and must be billed under the pharmacy benefit.

Programs

• Excluded Drugs – Shows drugs that are excluded from coverage, as well as how to request a formulary exception.
• Lowest Net Cost Formulary – Applies to most of our benefit plans, with just a few exceptions.
• 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. 
• Specialty Pharmacy Drugs – Features drugs that are used to treat complex or chronic medical conditions.
• 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. 

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.