The information below applies to those with the National Performance Formulary prescription drug benefit plan. Members with this plan will see "Formulary: NPF" on the front of their ID card.
All Qualified Health Plan (QHP) members have the
National Performance Formulary prescription drug benefit plan.
2021 Drug Lists
Effective Jan. 1, 2021 members covered under the National Performance Formulary (NPF) prescription drug benefit should refer to the below 2021 drug lists. Note, the prior approval lists are NOT all-inclusive and coverage is not guaranteed. You should verify coverage before filling prescriptions.
- 2021 Preferred Brand Name Drugs (as of 01/01/2021)
- 2021 Drug EXCLUSIONS (as of 01/01/2021)
Please Note: Drugs for erectile dysfunction and infertility are not covered for QHP members.
*Newly approved drugs may be excluded from coverage until the ESI formulary development process is completed.
- 2021 Drug EXCLUSIONS (effective 04/01/2021)
Please Note: Drugs for erectile dysfunction and infertility are not covered for QHP members.
*Newly approved drugs may be excluded from coverage until the ESI formulary development process is completed.
- 2021 Prior Approval List (as of 03/02/2021)
- 2021 Step Therapy List (as of 12/31/2020)
- 2021 Quantity Limits (as of 12/31/2020)
- 2021 Wellness Drug List (as of 10/01/2020)
Review our current wellness drug list to see if your medication is eligible for special benefits.
- List of drugs that are excluded from coverage due to unique packaging and/or where there is a therapeutic alternative.
Unique Packaging and Therapeutic Alternatives (UPTA) Excluded Drug List (04/24/2020)
- 2021 National Performance Formulary Annual Booklet (as of 01/01/2021)
** ATTENTION VEHI PLATINUM and GOLD Members **
Drugs listed as tier 1 (generic) will be either $4 or $10. A list of $4 generics can be found here (strength and dosage form may limit inclusion):
2021 Vermont Education Health Initiative (VEHI) Generic Drug List
(effective 01/01/2021)
Verify Coverage Before Filling Prescriptions
We encourage you to call Express Scripts at (877) 493-1947 to verify coverage for a drug before filling it.
Drugs Dispensed in Medical Settings
All drugs dispensed in a medical setting will follow the criteria of the member's formulary. If the member does not have their retail pharmacy benefit with Blue Cross and Blue Shield of Vermont, then the Blue Cross and Blue Shield of Vermont Formulary criteria will be used for drugs that require prior authorization.
Benefit Exceptions for Excluded Medications
To request a benefit exception for excluded medications from the National Performance Formulary:
- Call Express Scripts at (800) 313-7879 or
- Go to CoverMyMeds
Prior Approval Process
To obtain prior approval for a NPF prescription drug:
Call Express Scripts at (800) 313-7879 or
Use CoverMyMeds (online prior approval option)
Updated: 11/25/2020