Pharmacy Benefits
Your pharmacy benefits will be managed by BlueCross BlueShield. This page provides lots of useful information regarding your pharmacy benefits through Vallen. See your 2026 Benefits Guide for an overview now! If you are a current member of the Plan, you can sign into My Health Toolkit from this website to view personalized information about your pharmacy benefits. For members new to the Plan, information via My Health Toolkit will be available to you after January 1st.
Pharmacy Network
There are almost 70,000 pharmacies in the network. All major chains, as well as many independent drug stores, are included. Always make sure your pharmacy is part of our network before you have your prescriptions filled. Use the Find a Pharmacy link on the right-hand side of this page to search for a participating pharmacy.
Premium Formulary
Your prescription drug benefit is based on a list of covered drugs called the BlueCross Premium Formulary. A group of network doctors and pharmacists choose the drugs for the formulary based on their effectiveness, safety and value. If you want to save the most on your drug costs, ask your doctor if a generic or preferred brand-name drug is right for you.
The formulary is subject to change without notice, but typically changes quarterly. Use the searchable tools on the righthand side of the page to find out more about how prescription drugs are covered under your plan.
Prescription Drug List: Your new pharmacy benefit is based on tiers. Tiers are the different cost levels you pay for medications such as generics (tier 1), preferred brands (tier 2), non-preferred brands (tier 3) and specialty (tier 4). Use this tool to find out more about what copay tier a drug is on, if it’s a specialty drug and whether it has any limitations such as Prior Authorization, Step Therapy or Quantity Management.
90-day prescriptions
Your pharmacy benefit will continue to require you to fill 90-day prescriptions for maintenance drugs, after two 30-day grace fills at any participating in-network retail pharmacy. The new program is called WAG90 Saver Plus. You have two options to have your maintenance medications filled:
Home Delivery: OptumRx Home Delivery will be your mail-service pharmacy. You can contact the Home Delivery pharmacy at 855-811-2218.
Walgreens Retail pharmacies: You can also have your 90-day prescriptions filled at any participating Walgreens pharmacy.
Drug Exclusions
From time to time, our pharmacy committee may decide to no longer cover some drugs when other safe, effective, less costly alternatives are available. View information about
Excluded Drugs and how your doctor can request a formulary exception. Use this tool to determine if a drug is covered.
Specialty Drugs
Specialty prescription drugs treat complex or chronic medical conditions. These drugs are usually dispensed by pharmacies that specialize in specialty drugs.
View information on specialty drugs. Any drug on the specialty drug list must be purchased at Optum Specialty Pharmacy for the charges to be covered under your pharmacy benefit. Use this tool to determine if a drug is on the specialty drug list.
Please call the specialty pharmacy at 877-259-9428. A representative will help you get set up and can also contact your doctor for a new prescription, if needed.
Specialty copay cards: If you use a specialty copay card or coupon to reduce your out-of-pocket cost for a specialty drug, please inform the specialty pharmacy during your first call. Also, the portion of your copay paid by the manufacturer will not accumulate towards your deductible or out of pocket maximums.
Prior Authorization Program
If you are prescribed a medication that is included in our Prior Authorization program, your doctor must request and receive prior approval before your plan will cover that drug. View Drug Prior Authorization information about how your doctor can request prior authorization. Use this tool to determine if a drug requires prior authorization.
Quantity Management Program
Quantity Management limits the amount of certain medications that we cover. For most medications, your benefit will only cover a set amount within a set time frame. View the Quantity Management information on how your doctor can request a medical necessity override to allow a larger amount of some of the drugs in this program. Use this tool to determine if a drug is part of the Quantity Management Program.
Step Therapy Program
Several medical conditions can be treated using a variety of drugs. In some cases, there is a very large difference in cost of the medications. Many people find the more cost-effective medications work just as well for them. Step Therapy requires members to try more cost-effective prescription drugs before trying (or “stepping up to”) more expensive ones. If you have not tried a more cost-effective alternative in the recent past, you must do so or your doctor must request an exception before you will have coverage under your plan. View the Step Therapy information to se if a drug falls in this program and how your doctor can request an exception, if appropriate.
Opioid Management Program
To help combat the ongoing national opioid crisis, we have implemented a program based on U. S. Centers for Disease Control and Prevention (CDC) guidelines. It consists of daily quantity limits specific to each covered opioid drug and prior authorization requirements for certain prescribing situations. There are also limitations on the amount of opioid medication we will cover for first-time prescriptions.