In most cases, a prescription drug may be covered under your pharmacy benefit. There are times, though, when a prescription drug is considered a medical benefit.
Medical Benefit Therapeutic Alternatives
Certain prescription drugs, given to you by a health care professional in a clinical or professional setting, have therapeutic equivalents or therapeutic alternatives that are used to treat the same condition. Your Blue Cross and Blue Shield of Montana health plan benefits may only cover select therapeutic equivalent or therapeutic alternative drugs.
Drugs on this list have been reviewed and determined to work just as well as the non-covered product. This list is subject to change.
What if my medication is not covered under my medical benefits?
The medication may be covered under your pharmacy benefits, based on your benefit plan.
If not, you, an authorized representative or your health care provider can call the number on your member ID card to ask for an exception. You and your provider will be told if the request is approved or denied.
¿Necesita más ayuda?
- Visite nuestra página centro de ayuda to get answers to health insurance questions.
- Register or log in to your Blue Access for Members℠ member account.
- Call us at the number on your member ID card.
Pharmacy vs. Medical Benefit
Beneficios médicos
Drugs covered by medical benefits must be given to you by a health care professional in a health care setting.
Beneficios farmacéuticos
Drugs covered by pharmacy benefits are prescribed drugs you can take on your own.