2025 Drug List (Therapeutic Class Drug List) - Blue Cross Blue Shield of Illinois
This document is the BCBSIL 2025 Drug List describing covered pharmacy drugs, tier placement, special requirements (PA, ST, QL, SP, AC), dispensing/quantity limits, specialty pharmacy referral (Accredo), exception and expedited review processes, and member/provider guidance for drug coverage and use.
No material clinical or coverage changes (has_material_change = false).
Coverage Summary & Scope
Coverage / Special Requirements
Coverage / Special Requirements: The following criteria summarize how the formulary uses special requirement flags and the general coverage statement applied to drugs on the BCBSIL Drug List.
ALL of the following
- General coverage statement: Drugs shown on the Drug List are eligible for coverage under the pharmacy benefit when the member has pharmacy coverage and the drug is included in the member’s specific benefit plan. Drugs not shown on the list are not covered through the pharmacy benefit unless otherwise specified in plan materials or approved via exception/medical benefit.
- Prior Authorization (PA): A PA flag indicates that a clinical review is required before the plan will cover the drug. The prescriber must submit the required clinical information and supporting documentation. Coverage is approved only when the clinical criteria are met and the PA is granted. Some plans may require PA for additional drugs beyond those flagged in this document; refer to the member’s benefit plan for specifics.
Prior authorization requests should include relevant diagnoses, previous therapies tried, and supporting clinical documentation to avoid delay.
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