Jump to Content
Medicare Plus Blue PPOSM and Prescription Blue PDPSM formularies
Medicare Plus Blue PPO and Prescription Blue PDP plans include prescription drug coverage. These plans will generally cover drugs listed in our formulary as long as:
- The drug is medically necessary
- The prescription is filled at network retail or mail-order pharmacies
- All other plan rules are followed
The formulary document provides a brief description of the plans' benefits, including any deductibles. It is updated regularly.
Please choose a plan below for formulary information.
Medicare Plus Blue PPO VitalitySM
- Medicare Plus Blue PPO Vitality Comprehensive Drug Formulary - Updated November 2011 (PDF 446KB)
- Medicare Plus Blue PPO Vitality Formulary Changes - Updated March 2012 (PDF 104KB)
- Medication Therapy Management Program
- Utilization Management (prior authorization, step therapy criteria, quantity limit restrictions and other programs) (PDF 109KB)
Medicare Plus Blue PPO SignatureSM and Prescription Blue PDP Option A
- Medicare Plus Blue PPO Signature and Prescription Blue PDP Option A Comprehensive Drug Formulary - Updated October 2011 (PDF 484KB)
- Medicare Plus Blue PPO Signature and Prescription Blue PDP Option A Formulary Changes - Updated March 2012 (PDF 104KB)
- Medication Therapy Management Program
- Utilization Management (prior authorization, step therapy criteria, quantity limit restrictions and other programs) (PDF 109KB)
Medicare Plus Blue PPO AssureSM and Prescription Blue PDP Option B
- Medicare Plus Blue PPO Assure and Prescription Blue PDP Option B Comprehensive Drug Formulary - Updated October 2011 (PDF 495KB)
- Medicare Plus Blue PPO Assure and Prescription Blue PDP Option B Formulary Changes - Updated March 2012 (PDF 104KB)
- Medication Therapy Management Program
- Utilization Management (prior authorization, step therapy criteria, quantity limit restrictions and other programs) (PDF 120KB)
Additional resources:
- Beers Drug Report
- Drug management programs
- 2011 Medicare Plus Blue PPO and Prescription Blue PDP
- Medicare Plus Blue PPO Vitality Comprehensive Drug Formulary - Updated September 2010 (PDF 439KB)
- Medicare Plus Blue PPO Vitality Formulary Changes - Updated August 2011 (PDF 199KB)
- Medicare Plus Blue PPO Signature and Prescription Blue PDP Option A Comprehensive Drug Formulary - Updated October 2010 (PDF 484KB)
- Medicare Plus Blue PPO Signature and Prescription Blue PDP Option A Formulary Changes - Updated August 2011 (PDF 199KB)
- Medicare Plus Blue PPO Assure and Prescription Blue PDP Option B Comprehensive Drug Formulary - Updated October 2010 (PDF 487KB)
- Medicare Plus Blue PPO Assure and Prescription Blue PDP Option B Formulary Changes - Updated August 2011 (PDF 208KB)
- Drug management documents
- Medicare Plus Blue PPO Vitality, Signature and Prescription Blue PDP Option A Quantity Limit Restriction List (PDF 83KB)
- Medicare Plus Blue PPO Vitality, Signature and Prescription Blue PDP Option A Prior Authorization / Step Therapy Program (PDF 109KB)
- Medicare Plus Blue PPO Assure and Prescription Blue PDP Option B Quantity Limit Restriction List (PDF 89KB)
- Medicare Plus Blue PPO Assure and Prescription Blue PDP Option B Prior Authorization / Step Therapy Program (PDF 120KB)
