Pharmacy coverage

Log in to your Blue KC member account to reach the Pharmacy page.

If you have questions about this information, or your pharmacy coverage in general, please call the pharmacy customer service line listed on your Blue KC member ID card.

Yes, up to two years of your prescription claims history is available. To access, log in to your member account to reach Plan Benefits and your pharmacy plan information.

If you have already tried a medication that Blue KC is requiring you take as part of the step therapy program, your doctor can request an exception to the rules and limitations by submitting an online prior authorization request that includes your medical history documentation here.

Blue KC may make changes to the formulary (prescription drug list) over the course of the year. If you received a letter about a formulary change, it means that one or more of your medications is being reclassified, resulting in price changes, updated authorization requirements, and/or new quantity limitations. Formularies undergo changes because new medications are continuously introduced to the market and additional research can result in existing medications gaining approval for new uses and treatments. This results in lower-cost alternatives becoming available to treat a condition you may have. To make sure you are viewing the correct prescription drug list, log in to your member account and refer to the Prescription Drug List section and link.

Access the Prescription Drug List:

Employer-Covered members: View prescription drug list here

Individual & Family plan members: View prescription drug list here

Before you join a separate discount program, Blue KC’s pharmacy benefit site now offers a Price Edge solution where a number of generic medications cost less than what you may find offered through other programs. That said, if you can find a better price at Good Rx or elsewhere, you can certainly use that program. Please note that any price you pay for prescriptions while using outside programs will not be applied towards your deductible or out-of-pocket maximum spending limits. Log in to your member account to Compare Prices.

Drug manufacturers sometimes provide coupons that cover a limited amount of medication at a low price. Pharmacies will accept coupons you provide them and, at times, apply these coupons on your behalf when they have access to them. The price you do pay for that medication when a coupon has been used may not be applied towards your deductible or out-of-pocket maximum spending limits. Be aware that the price of future refills may be quite different from what you previously paid while using a coupon.

Blue KC’s pharmacy benefit site allows you to search for weight-loss medications and view related coverage and cost information. Enter the name of the medication you’re taking or interested in, and search results will clearly tell you whether or not a medication is covered by your plan. If covered, most weight-loss medications do require you to obtain prior authorization, which your doctor can submit to Blue KC for you. Log in to your member account to start your search.

Blue KC’s pharmacy benefit site allows you to quickly enter the name of the medication you’re taking or interested in, and search results will clearly tell you whether or not a medication is covered by your plan and / or requires prior authorization. If a medication is not covered, you will see alternatives to consider that are also used to treat your condition. Please note: Your plan will not typically contribute towards the cost of your prescription until you have met your plan’s deductible. Log in to your member account to start your search.

Prescription costs may vary based on whether you have met your plan’s deductible or out-of-pocket max spending limits for the plan year. While you may start out the year paying full price for a medication, the price you pay could reduce dramatically upon reaching those spending limits. To get the most up-to-date pricing that takes into account your current level of spending, use the Drug Pricing module on the pharmacy benefit site homepage to get started. Log in to your member account to start your search.

Blue KC partners with Rx Savings Solutions to help you save on the cost of your prescriptions. Enrolling in the Rx Savings Solutions program takes one click, and then the tool does the rest. Rx Savings Solutions monitors the medications you take to alert you of new savings opportunities via email or text. Savings can come in the form of trying an alternative or generic medication that treats your condition, through splitting a higher dose tablet in half, or by filling your prescription at a different pharmacy or through home delivery. Log in to your member account to start saving.

Go here to learn how Blue KC helps you save, including Rx Savings Solutions–our pharmacy savings program.

Step therapy is all about taking one “step” at a time when determining which treatment or medicine works best for you. Blue KC may recommend that you first try medicine A based on the latest medical literature and research. If medicine A doesn’t work as expected, then you can try medicine B, then medicine C, if necessary. This works similarly for treatments where we may require physical therapy before moving forward with a surgical procedure, for example. Step therapy helps you avoid spending money on more expensive care when a proven, more cost-effective alternative exists.

Already tried a required medication? Here’s what to do:
If you have already tried a medication that Blue KC is requiring you to take as part of the step therapy program, your doctor can request an exception to the rules and limitations by submitting an online prior authorization request that includes supporting documentation. We also provide a form for members to submit these requests but recommend your doctor complete this step because they have your full set of medical records that allow us to complete a fair and thorough review.

To have a prescription refilled early, have your pharmacist call the Pharmacy Customer Service unit at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

Yes, show your member ID card to your pharmacist whenever you have a prescription filled. Your prescription claim is electronically transmitted to Blue KC when you fill your prescription. Please make sure the pharmacy has your most current health insurance information and correct birth date so there won’t be any delays or claim denials when we process your claim.

A maintenance drug is a medication used to treat a chronic condition like diabetes or high blood pressure. The FDA must approve maintenance drugs as safe for long-term use. Blue KC uses a national drug information database called First DataBank to determine which medications are included on the maintenance drug list. If your prescription is a maintenance drug, you can have it filled for several months instead of just one prescription at a time.

The Prescription Drug List (PDL) is a list of prescription medications that have been reviewed and recommended by the Blue KC Medical and Pharmacy Management Committee. The list has a combination of brand name and generic medications. Each of these medications has been reviewed for its safety, effectiveness, clinical outcomes, and cost. Physicians and pharmacists on the committee look at drug utilization issues, the number of adverse events, and any proven advantages over other drugs on the PDL. The most efficient and cost effective drugs are on Tier 1 of the PDL. All other drugs are designated Tier 2 or Tier 3 status.

To make sure you are viewing the correct prescription drug list, log in to your member account and refer to the Prescription Drug List section and link.

Access the Prescription Drug List:

Employer-Covered members: View prescription drug list here

Individual & Family plan members: View prescription drug list here

A generic equivalent is a medication that contains the same active ingredient and works the same way as the original brand name drug. A generic alternative is a generic medication that may not have the same active ingredient, but works in the same way as another drug. An example of a generic alternative is ranitidine. It is the generic equivalent of Zantac®, but it works in the same way to relieve stomach acid as Axid® and Pepcid®.

Zantac, Axid, and Pepcid are the same “class” of medicine but contain different active ingredients. So, the generic form of Zantac, “ranitidine,” is a lower cost alternative in the same class of medicine as Axid and Pepcid.

When a drug company develops a new medication they apply for a patent. This patent protects the drug from being copied by other drug companies for a certain period of time. These drugs are brand name drugs. Once the patent period expires, other manufacturers can produce the same drug as long as they follow strict guidelines established by the Food and Drug Administration’s (FDA) guidelines. These same drugs are generic drugs. Generic drugs are less expensive versions of those brand name drugs whose patents have expired. They are made with the same active ingredients of the brand name drug, but they may have a different color, shape or filler material. The cost of a generic drug is typically less than a brand name drug. All generic medications are approved by the FDA before they are released on the market. Some examples of generic drugs and their brand name equivalent include furosemide and Lasix®, ranitidine and Zantac®, and cephalexin and Keflex®.

Prior authorization (PA) means you must get approval before your plan will cover your medication. PA is used to make sure the medication you’re taking is appropriate and effective for your condition. To start the prior authorization process, your doctor can access BlueKC.com. Your doctor will need to provide more information about why you are taking a medication.

Some medications have lower-cost equivalents available. Step therapy is a process that requires you to first try more cost-effective medications before “stepping up” to medications that cost more. This process ensures you get the safest, most effective and reasonably priced medication available.

When a medication changes tiers, you may pay more or less for that medication, depending on the tier change. If one of your medications changes to a higher tier, talk with your doctor to decide if a lower-cost option may be available.

A formulary (also known as a Prescription Drug List or PDL) is a list of the most commonly prescribed medications covered by your plan. The list includes both brand-name and generic prescription medications approved by the Food and Drug Administration (FDA). Medications are listed by common categories or classes and placed in tiers that represent the cost you pay out of pocket. This makes it easier for you and your doctor to find other options to help you save money. To make sure you are viewing the correct prescription drug list, log in to your member account.

Access the Prescription Drug List:

Employer-Covered members: View prescription drug list here

Individual & Family plan members: View prescription drug list here

Specialty medications treat chronic conditions such as cancer, multiple sclerosis and rheumatoid arthritis. They can be an injectable, oral or inhaled medication with one or more of the following characteristics:

• May require ongoing clinical oversight and additional education for best management.
• May have unique storage or shipping requirements.
• May not be available at retail pharmacies.

You can track your home delivery order status online by logging into your member account to reach the Pharmacy page.

Log in to your Blue KC member account to reach the Pharmacy page to learn more and set up home delivery.

Log in to your Blue KC member account to reach the Pharmacy page.

If you have questions about this information, or your pharmacy coverage in general, please call the pharmacy customer service line listed on your Blue KC member ID card.

The Prescription Drug List is a list of prescription medications that have been reviewed and recommended by Blue KC’s Medical and Pharmacy Management Committee. Feel good knowing that each medication has been reviewed for safety, effectiveness, clinical outcomes and cost.

Access the Prescription Drug List:

Employer-Covered members: View prescription drug list here

Individual & Family plan members: View prescription drug list here