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Medicaid

BlueCross BlueShield of Western New York can help you get the most out of your Medicaid benefits. Get vision care, dental benefits, prescriptions, mental health services and more! See doctors and pick up prescriptions close to home. Use our 24/7 NurseLine to get reliable medical advice any time, day or night.

Your health is important to us. That’s why you get important care and services like:
  • A primary care provider (PCP) to help you get the care you need.
  • Prescriptions*.
  • Wellness visits and immunizations.
  • Specialty physician services.
  • Substance use treatment.
  • Psychiatric services.
  • Disease management for asthma, diabetes and more.
  • Smoking cessation.
  • Coping, crisis prevention, stress management, and life skills training.
  • Family support training.

*Copays may apply for medications. There are no copays for services that are part of your benefits.

Frequently asked questions

How do I get help after my primary care provider’s (PCP) office closes?

Unless it’s a life-threatening emergency, do not go to the emergency room (ER). Instead, call the 24/7 NurseLine at 1-866-231-0847 (TTY 711) to talk to a nurse any time, day or night. Our nurses can answer questions about your health or help you find an urgent care facility near you.

Can I call my specialist’s office directly to set up an appointment?

Your PCP will refer you to a specialist. If you need specialist services you can’t get from a BlueCross BlueShield plan doctor, we’ll work with your PCP to refer you to an out-of-plan specialist. Your PCP must call BlueCross BlueShield at 1-866-231-0847 (TTY 711) to request approval for an out-of-plan referral.

My plan has dental benefits. How do I choose a dentist?

If you need to find a dentist, please call Healthplex toll free at 1-800-468-9868 (TTY 1-800-662-1220) Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 9 a.m. to 5 p.m. Eastern time. You can also call Member Services at 1-866-231-0847 (TTY 711). When you visit your dentist, you should show your plan ID card.

How do I get a copy of the BlueCross BlueShield provider directory?

Please call Member Services at 1-866-231-0847 (TTY 711) and request one. You can also view our provider directory online.

How do I see a doctor who is not a BlueCross BlueShield plan doctor?

Please call Member Services at 1-866-231-0847 (TTY 711) Monday through Friday from 8:30 a.m. to 6 p.m. Eastern time with questions.

Enroll in BlueCross BlueShield

Can I call my specialist’s office directly to set up an appointment?

You need a referral from your PCP to see a specialist.  Learn more about how to get specialty care and referrals.

With BlueCross BlueShield of Western New York, you get extra benefits like:
  • New Baby, New LifeSM — a special program for pregnant women to:
    • Help you have a healthy pregnancy and a healthy baby
    • Provide education and emotional support
    • Give information on services and resources in your community
  • Comprehensive programs for chronic conditions like diabetes, asthma, hypertension, stress management, weight control and more
  • Health home care management

Enroll in BlueCross BlueShield

Your pharmacy benefits

BlueCross BlueShield of Western New York works with Express Scripts to give you pharmacy benefits. Get low-cost prescriptions and over-the-counter (OTC) medications.

Your Costs

  • $3 for brand-name drugs
  • $1 for generic drugs

Preferred Drug List

BlueCross BlueShield has a preferred drug list (PDL), also called a formulary. It includes all medicines covered by Medicaid and Child Health Plus (CHPlus). Your doctor doesn’t have to get preapproval to prescribe medicines on this list. If your doctor wants to prescribe a drug that isn’t on this list, he or she will need to get preapproval from us before you can fill your prescription.

When there is a generic drug available, it will be covered. Generic drugs are equal to brand-name drugs and approved by the Food and Drug Administration. Requests for brand-name drugs when generics are available will need preapproval. You can email us to ask for an exception.

Preferred Drug List

If you have any questions about your pharmacy benefit, please call Member Services at 1-866-231-0847 (TTY 711) Monday through Friday from 8:30 a.m. to 6 p.m. Eastern time.

Searchable Formulary

Search for brand-name and generic drugs that are on your medication list.

You can search for your drug by:
  • Typing the name (at least first three letters) of the drug in the search box.
  • Using the A-Z list to search by the first letter of your drug. OR
  • Clicking on therapeutic class of the drug.

Searchable Formulary

Drug Interactions and Side Effects

Learn more about drug interactions or side effects on the ESI drug information website.

Getting your prescription filled is easy!

Simply take your prescription to a plan pharmacy. Find a pharmacy here. Your doctor can also call in the prescription to your local plan pharmacy. You will need to show your BlueCross BlueShield ID card to have a prescription filled.

It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about any medicines you’re taking.

Our new Medication Synchronization program (Med Sync) makes getting all your medicines easier – at no extra cost to you. Med Sync helps align your refill schedules so you can pick up most of your medicines on just one day each month. Learn more about Med Sync:

You can use the links below to get more pharmacy information:

Express Scripts Member Reimbursement Form
Common Over-the-Counter (OTC) medicines
Express Scripts Online Registration
Express Scripts Mail Order Form

Frequently asked questions

How can I find out what pharmacies are in the BlueCross BlueShield plan?

You can look in your new member enrollment package for a list of pharmacies in our plan. Or you can search our list of plan drugstores online. You can also call Member Services at 1-866-231-0847 (TTY 711) Monday through Friday from 8:30 a.m. to 6 p.m. Eastern time or ask your local pharmacy for help.

Are over-the-counter (OTC) products covered, and do I need a prescription?

We cover many OTC products, including pain relievers, antacids, contraceptives and some vitamins. All OTC products require a written prescription from your doctor and can be filled at any drugstore in our plan.

How does my doctor request preapproval?

Your doctor can call our Pharmacy department at 1-866-231-0847 (TTY 711).

What if a copay is required and I’m unable to pay it?

If you don’t have the required copay, your pharmacy (drugstore) should still provide the medicine. You will have to pay the copay at a later time.

How do I get medicine if I’m traveling?

We have pharmacies in our plan in all 50 states. If you need a refill while on vacation, ask your doctor for a new prescription to take with you. You can also ask your doctor to fax it to the closest drugstore in our plan where you’ll be visiting.

What happens if my medicines are lost or stolen?

If your medicines are lost or stolen, you should contact your doctor. Ask your doctor to authorize the pharmacy to refill your prescription early. The pharmacy may have to contact us for preapproval. Replacement of lost or stolen medicines will be reviewed on a case-by-case basis.

What if I paid out of pocket for a medicine and want to be reimbursed?

If you had to pay for a medicine, you may submit a request for reimbursement. You’ll need to mail a completed reimbursement request form along with any receipts to:
Express Scripts
P.O. Box 14711
Lexington, KY 40512

Will I be able to receive my enteral nutrition, diapers and medical supplies through a pharmacy?

Enteral nutrition, diapers and durable medical equipment (DME) can be obtained through your (DME) benefit. You can get some medical supplies from your local pharmacy, like bandages, insulin syringes and glucose test strips.

Enroll in BlueCross BlueShield

We offer New York State-sponsored Medicaid programs. BlueCross BlueShield of Western New York will help you get the most out of your Medicaid benefits.

You may be eligible for Medicaid if:
  • You live in one of these counties: Allegany, Cattaraugus, Chautauqua, Erie, Orleans or Wyoming.
  • You have high medical bills.
  • You receive SSI — see below.*
  • You meet certain income, resource, age or disability requirements.g.

*If you receive Supplemental Security Income (SSI), you automatically receive Medicaid without the need to apply.

You may be eligible for SSI if you:
  • Are elderly.
  • Are blind.
  • Have a disability.
  • Have a behavioral health condition.

Families who don’t qualify for Medicaid may still get health care for their children.

To find out more about eligibility, visit the New York Medicaid website or call NY State of Health, The Official Health Plan Marketplace at 1-855-355-5777.

Already a member and have questions?

Please call Member Services at 1-866-231-0847 (TTY 711) Monday through Friday from 8:30 a.m. to 6 p.m. We are happy to help you with your health care!

Enroll in BlueCross BlueShield

Your member handbook is your go-to guide for health services. It tells you how you can get the most from BlueCross BlueShield of Western New York. You’ll find answers to these items:

  • Your benefits
  • Your rights and responsibilities.
  • How to get helpt after your doctor's office closes
  • How to choose a primary care provider
  • Renewing your coverage
  • How to reach Member Services if you have a question
Member Handbooks
Notice of Privacy Practices
Quality Improvement Overview

New Baby, New Life℠ BlueCross BlueShield Healthy Rewards Incentives

  • Earn 250 points ($25) in rewards for attending a prenatal visit in the first trimester or within 42 days of enrollment into BlueCross BlueShield.
  • Earn 250 points ($25) in rewards for attending at least six prenatal care visits.
  • Earn 250 points ($25) in rewards for attending postpartum visit 21 to 56 days after delivery.
  • Earn 250 points ($25) in rewards for baby’s checkup by 2 weeks of age.
  • Earn 250 points ($25) in rewards for attending at least six well-child checkups by 15 months of age.

For more information, check online at www.bcbswny.com/healthyrewards or call 1-800-749-9036.