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When the member buys a drug or supply, the pharmacist will dispense a generic equivalent of the prescribed drug whenever allowed.

For certain drugs, prior approval is required from Blue Cross Blue Shield in order for the member to receive these drug benefits. The covered Pharmacy will tell the member if a drug needs prior approval and how to request this approval.

Covered drugs and supplies include:

Drugs that require a prescription by law and are furnished in accordance with Blue Cross Blue Shield medical technology assessment guidelines. These include: birth control drugs; oral diabetes medication that influences blood sugar levels; hormone replacement therapy drugs for peri- and post-menopausal members; certain drugs used on an off-label basis (such as drugs used to treat cancer and drugs used to treat HIV/AIDS); abuse-deterrent opioid drug products on a basis not less favorable than non-abuse deterrent opioid drug products; oral antibiotics for the treatment of Lyme disease; and drugs for HIV associated lipodystrophy syndrome.

Injectable insulin and disposable syringes and needles needed for its administration, whether or not a prescription is required. If insulin, syringes and needles are bought at the same time, the member pays two copayments (when a copayment applies): one for the insulin; and one for the syringes and needles.

Materials to test for the presence of sugar, including blood glucose monitoring strips, ketone strips, lancets, urine glucose testing strips, normal, low and high calibrator solution/chips and dextrostik or glucose test strips when ordered by a Physician for home use.

Insulin injection pens.

Insulin infusion pumps and related pump supplies. (The insulin infusion pump must be obtained from an Appliance Company instead of a Pharmacy. For the insulin infusion pump itself, the cost the member would normally pay for covered drugs and supplies will be waived. The only exception is for deductible amounts when an overall plan deductible applies for covered drugs and supplies.)

Diaphragms (the member pays the same amount that is normally paid for generic drugs).

Prescription prenatal vitamins and pediatric vitamins with fluoride.