Prescription Drug Formulary1   Updated 10/01/08

Medicare Blue PPO Formulary  

Prescription Drugs With Quantity Limits [File: 112 KB] - Updated 07/07/08

Maintenance Drug List    [File: 117 KB]  

Specialty Pharmacy Program

¹ Note: Blue Cross and Blue Shield of Oklahoma health plans offered by self-insured employer groups may have different coverage options, plans or benefits. Please refer to your health plan contract, which governs eligibility, coverage exclusions and available benefits.

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Drug Card Prescription Claim Form

Lincs Rx Claim Form [File: 48 KB]

Lincs Rx NCPDP Version 5.1 Payor Sheet [File: 87 KB]

Medicare Blue Rx (Part D) Payor Sheet [File: 277 KB]

Medicare Blue PPO Payor Sheet [File: 204 KB]

PPI Step Therapy Process Description  [File: 238 KB] - Updated 07/01/08

ADHD Step Therapy Process Description  [File: 137 KB]

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