The CareFirst BlueCross BlueShield Advantage DualPrime Formulary is a list of drugs covered by the plan. Formularies are developed to meet the needs of most members based on the most commonly prescribed drugs, including certain prescription drugs that Medicare requires that we cover. The CareFirst BlueCross BlueShield Advantage DualPrime Medicare Part D formulary is approved by Medicare and updated throughout the plan year and may change if:
CareFirst BlueCross BlueShield Advantage DualPrime covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as their brand-name equivalents. Generic drugs usually cost less than brand-name drugs and are rated by the U.S. Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
We may remove drugs from the CareFirst BlueCross BlueShield Advantage DualPrime Part D formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, and/or move a drug to a higher cost-sharing tier during the plan year. If the change affects a drug you take, we will notify you at least 60 days before the change is effective. However, if the U.S. Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe, or if the drug's manufacturer removes the drug from the market, we may immediately remove the drug from the CareFirst BlueCross BlueShield Advantage DualPrime Medicare Part D formulary and notify all affected members as soon as possible.
Search Our 2023 Online Formulary/Drug List
Download a copy of our 2023 Comprehensive Formulary/Drug List
Our plan uses different types of utilization management tools to help our members use drugs in the most effective ways.
Prior Authorization: Approval in advance to get certain drugs that may or may not be on our formulary.
For covered drugs requiring “Prior Authorization” your prescribing provider will need to include any clinical information and supporting documentation along with the Request for Medicare Prescription Drug Coverage form.
Step Therapy: A utilization tool that requires you to first try another drug to treat your medical condition before we will cover the drug your physician may have initially prescribed.
Quantity Limits: A management tool that is designed to limit the use of selected drugs for quality, safety, or utilization reasons. Limits may be on the amount of the drug that we cover per prescription or for a defined period of time.
Our searchable “online” formulary and downloadable PDF formulary provides a comprehensive listing of all drugs that are covered by CareFirst Medicare Advantage. For each drug listed we let you know if there is any utilization management tool or restriction to the drug.
In addition, our searchable “online” formulary will also provide you with the applicable clinical criteria for each drug that has a utilization management tool/restriction.