National Preferred Formulary (NPF)
The information below applies to those with the National Preferred Formulary prescription drug benefit plan. Members with this plan will see "Formulary: NPF" on the front of their ID card.
All Qualified Health Plan (QHP) members have the
National Preferred Formulary prescription drug benefit plan.
2019 Drug Lists
Effective Jan. 1, 2019 members covered under the National Preferred Formulary (NPF) prescription drug benefit should refer to the below 2019 drug lists. Note, the prior approval lists are NOT all-inclusive and coverage is not guaranteed. You should verify coverage before filling prescriptions.
- 2019 Prior Approval List (as of 07/09/2019)
- 2019 Step Therapy List (as of 07/22/18)
- 2019 Quantity Limits (as of 07/08/19)
- 2019 Preferred Brand Name Drugs (as of 01/01/19)
- 2019 Drug EXCLUSIONS (as of 07/01/2019)
Please Note: Drugs for erectile dysfunction and infertility are not covered for QHP members.
*Newly approved drugs may be excluded from coverage until the ESI formulary development process is completed.
- 2019 NPF Annual Booklet
- Wellness Drug List
Review our current wellness drug list to see if your medication is eligible for special benefits.
Verify Coverage Before Filling Prescriptions
We encourage you to call Express Scripts at (877) 493-1947 to verify coverage for a drug before filling it.
Drugs Dispensed in Medical Settings
All drugs dispensed in a medical setting will follow the criteria of the members formulary. If the member does not have their retail pharmacy benefit with BCBSVT, then the Open Formulary criteria will be used for drugs that require prior authorization.
Benefit Exceptions for Excluded Medications
To request a benefit exception for excluded medications from the National Preferred Formulary:
- Call Express Scripts at (800) 313-7879 or
- Go to CoverMyMeds
Prior Approval Process
To obtain prior approval for a NPF prescription drug:
Call Express Scripts at (800) 313-7879 or
Use CoverMyMeds (online prior approval option)