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MediBlue(SM) Formulary

The MediBlueSM formulary is a list of drugs, selected by MediBlueSM in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. MediBlueSM will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a MediBlueSM network pharmacy, and other plan rules are followed.  
The formulary provides a chart that defines the four tiers into which the formulary drugs are placed, as well as the co-payment for drugs in each tier. The tier of each drug is listed next to the drug name.  
You will be notified of updates and changes to the MediBlueSM formulary at least 60 days prior to their implementation. All updates and changes will be available via a link on this page, so be sure to check back here regularly. 

Section Title

MediBlueSM Formulary

Coming Soon 

MediBlueSM Abridged Formulary

PDF Format

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