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The Advice Centre

Blue RX Drug Formulary

Thursday, April 7, 2016
2   based on 149 votes
Get More from Your Benefits, Understanding your drug coverage

What is Blue RX?

Blue RX is a customized drug plan based on a managed formulary. Plain and simple, a formulary is a list of covered drugs. It is called a “managed” formulary because drugs are reviewed to ensure they are both clinically and cost effective before they are added to the plan

The Blue RX drug plan provides you with safe, high quality prescription drugs at an affordable price while you, your plan sponsor, and Pacific Blue Cross work together to manage the rising cost of drug expenses.

What is covered under my Blue RX plan?

Blue RX covers brand-name and generic prescription drugs used to treat all major diseases and conditions. For conditions where multiple drugs are available, only the drugs that offer cost-effective treatment are covered by the plan. Certain drugs will require prior approval from Pacific Blue Cross or BC PharmaCare before they are eligible for coverage. This is to make sure less expensive first line or alternative therapies have been considered and the patient has the right condition for the drug. This helps protect your drug plan from higher costs while ensuring you receive effective treatment for your health condition.

Click here to see a list of drugs that need prior approval.

How will I know which drugs need approval?

You can log into your Member Profile and type in your drug into the Drug Lookup tool and it will display whether the drug is covered or not, and whether prior approval is required.

Also, your pharmacist can submit your drug claim electronically to Pacific Blue Cross on your behalf. The pharmacist will alert you if prior approval is needed. Depending on the drug, approval may be required either by Pacific Blue Cross or by the BC PharmaCare Special Authority program.

Once a prior authorization form has been submitted, you will be notified of our decision in writing. If coverage for your drug is approved, you can log into your Member Profile, scroll down to the Your Recent Claims section > click View Pre-Authorizations > click the Drugs tab to find your approved drugs.

Are there drugs that are not covered?

There are a very small number of drugs that are not covered under Blue RX. These excluded drugs typically have similar therapeutic benefits to ones already covered by Blue RX but they are much more costly. There are often a variety of treatments available for a given health condition. These treatments often result in similar health outcomes, with great differences in cost. Blue RX covers drugs that offer cost-effective treatment without compromising health outcomes.

How do I apply for drugs that need prior approval from Pacific Blue Cross?

  1. Visit pac.bluecross.ca/bluerx to find out if your drugs require prior approval.
  2. Print a copy of the Blue RX Prior Approval Form specific to the drug coverage you are requesting. Find the forms at pac.bluecross.ca/bluerx or request them from us at 604 419-2000.
  3. Complete the first part of the form and have your doctor complete the remainder of the Blue RX Prior Approval Form. Send it to Pacific Blue Cross by fax 604 419-2689 (toll-free 1 888 419-2689) or mail:

    Pacific Blue Cross
    PO Box 7000
    Vancouver, BC V6B 4E1

    Where applicable, if your doctor is a specialist for your condition, he/she does not need to complete the form. Simply add the name of the specialist to the form or, if you have already filled the prescription, attach a copy of your pharmacy receipt showing the specialist’s name and send it to us.

    Please note any fees charged for completing the Blue RX Prior Approval Form are your responsibility and are not covered by your Extended Health Plan.

  4. Pacific Blue Cross will confidentially review the information and inform you of the decision

  5. If coverage for your drug is approved, you can log on to into your Member Profile, scroll down to the Your Recent Claims section > click View Pre-Authorizations > click the Drugs tab to find your approved drugs.

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