BlueRx Drug Formulary

BlueRx Limited Benefit Drugs

**NOTE: Prior approval for limited benefit drugs is only required if you have coverage under the BlueRx formulary. Members of a BlueRx plan will receive PBC Extended Health Care cards with the words BLUENET/BLUERX appearing on the bottom of the card. An example of the card is reproduced below:

If you are still not sure if your drug coverage is the BlueRx plan, contact your Plan Administrator or Pacific Blue Cross.

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Please login to CARESnet to download the BlueRx approval forms for Acne Therapy, Appetite suppressants and anti-obesity agents, Analgesics used for pain control, Peptic ulcer therapy drugs, Bio response modifiers for rheumatoid arthritis, Bio response modifiers for Crohn's disease