​​​​​​​Independence Blue Cross (IBX) and Independence Administrators support safe, effective, and affordable medication use through FDA-approved formularies reviewed by the Pharmacy and Therapeutics (P&T) Committee and administered by a pharmacy benefit manager (PBM). The PBM manages claims, works with network pharmacies, and monitors drug safety and prescribing patterns.

Providers should consult the formulary when selecting medications.

Formularies and coverage

Select Drug Program®

Drugs are organized into cost-sharing tiers:

• Low-Cost Generic: Lower copays for certain chronic condition medications.
• Generic: Lowest cost-sharing for most generic drugs.
• Preferred Brand: Higher cost-sharing for preferred brand-name drugs.
• Non-Preferred Drug: Highest cost-sharing for non-preferred drugs.

Brand-name drugs with available generics are typically covered at the non‑preferred level.
For Formulary access, download the latest Select Drug Program Formulary online or request a printed copy from IBX at 1-800-ASK-BLUE (1-800-275-2583) or from Independence Administrators at 1-888-356-7899.

Value Formulary

Structured similarly to the Select Drug Program, drugs not listed are considered non-formulary, with covered alternatives available. New drugs are added following P&T Committee review.

Non-Formulary Exceptions may be requested after trials of, or contraindications to, at least three alternatives. Approved requests are covered at the highest cost-sharing tier.

Fax exception requests to 1-888-671-5285. Download the latest Value Formulary online or request a printed copy from IBX at 1-800-ASK-BLUE (1-800-275-2583) or from Independence Administrators at 1-888-356-7899.

Cost-saving strategies

• Generic equivalents are FDA-approved and therapeutically equivalent to brand-name drugs at a lower cost. Brand prescribing may require prior authorization and could result in higher member cost sharing.
• Therapeutic alternatives are clinically comparable options within the same class (e.g., Dulera® alternatives include Advair® HFA, Symbicort®, Breo-Ellipta®). Although they are not the exact chemical equivalents of the brand-name drugs, therapeutic alternatives treat medical conditions in a similar way.
• Mail-order pharmacy is available for certain medications; requirements can be verified using the IBX Formulary Lookup Tool. To access, go to Drug Formularies, select the member's formulary, and then select Find a Formulary Drug. For Value Formulary members, the provider will also need to select a tier level before accessing the Lookup tool.

Specialty drugs

Specialty medications for chronic or complex conditions may require special handling, monitoring, or prior authorization. Benefits may vary, and many plans cover specialty drugs on a specialty tier with higher cost-sharing.

Exceptions and prior authorizations

Formulary tier exceptions are available for non‑preferred drugs when clinical criteria are met. Providers may request an exception for a non-preferred drug to be covered at a preferred level of cost-sharing when there has been a trial of, or contraindications to, at least three formulary alternatives.

• Drugs on the generic, preferred brand, and the specialty tiers are not eligible for a change to cost-share.
• Non-formulary drugs on the Value Formulary are not eligible for change to a lower cost-share. If approved for non-formulary exception, the member will pay the highest level of cost-sharing for these drugs.
• Brand-name drugs are not eligible for coverage on the generic tier.

The provider should complete the formulary exception form, providing details to support the request and fax it to the pharmacy benefit manager at 1-888-671-5285. If the tier exception request is approved, the provider will receive a fax notification, and the drug will be processed at the appropriate formulary level of cost-sharing. If the request is denied, the provider and member will receive a denial letter.

Prior authorization is required for select medications to confirm medical necessity. The process involves clinical evaluation of alternatives, dosing, and potential interactions. Requests may be submitted electronically through SureScripts™ or by completing a prior authorization form and faxing to 1‑888‑671‑5285 with supporting documentation.

Safe prescribing safeguards

IBX and Independence Administrators apply utilization and safety edits to support appropriate drug use, including:

• Age and quantity limits
• Morphine Milligram Equivalent (MME) Limits for daily opioid dosages to 90 MME; higher doses require prior authorization
• Cumulative Stimulant Limits
• Concurrent Drug Utilization Review (cDUR) at point of sale

Additional Information

Visit the Pharmacy Information section of the IBX website for detailed formularies, policies, and prescribing resources.

Your health plan uses an independent company to provide pharmacy benefits management services.

26-0057​