National Performance Formulary (NPF)

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Sample ID Card

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.


2020 Drug Lists 

Effective Jan. 1, 2020 members covered under the National Performance Formulary (NPF) prescription drug benefit should refer to the below 2020 drug lists. Note, the prior approval lists are NOT all-inclusive and coverage is not guaranteed. You should verify coverage before filling prescriptions.

 

** 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:

Vermont Education Health Initiative (VEHI) Generic Drug List.

 

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 Open 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: 06/30/2020