Transcription of 2021 Standard Comprehensive Formulary
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2021 Standard Comprehensive Formulary
Medicare Advantage Plans20 : 12/01/2021 Formulary 21363, Version 182021 Standard Comprehensive Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. This Formulary was updated on December 1, 2021. For more recent information or other questions, please contact us, Medicare Plus Blue Group PPO or prescription Blue Group PDP Customer Service, at 1 866 684 8216 or, for TTY users 711, Monday through Friday, 8:30 to 5 Eastern time. From October 1 through March 31, hours are from 8 to 9 Eastern time, seven days a week, or visit When visiting your doctor(s), please bring your personal drug list and this 2021 Blue Cross drug List with you.
You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January 1, 2022, and from time to time during the year.
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