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PHARMACY AND PRESCRIPTION PLAN INFORMATION
Prescription drugs are a vital part of your health care coverage. If you have prescription drug coverage through Blue Cross and Blue Shield of Texas (BCBSTX), this information can help you and your doctor get the most from your prescription drug coverage.
If you are a BCBSTX member, log in to Blue Access for MembersSM (BAMSM) to check your drug list and learn more about your prescription drug benefits. Be sure to review your benefit materials for details. If you have any questions about your prescription drug benefits, call the number on your member ID card.
Prescription Drug List
A drug list is a list of drugs that are covered under your prescription drug benefit. How much you pay out of pocket is determined by whether your drug is on the list and at what coverage level, or tier. A generic drug is often at the lower tier. See if your drug is covered.
Note: Based on your benefits, if you use a drug manufacturer’s coupon or copay card to pay for a covered prescription drug, this amount may not apply to your plan deductible or out-of-pocket maximum.
Some prescription drug plans may require you to pay more if you fill a prescription for a brand name drug when a generic equivalent is available. This Member Pay the Difference Program encourages members to use drugs that are safe, work well and are cost effective.
Please note: Health plans may administer medical and pharmacy coverage separately for select drugs. Some drugs are covered under your medical plan instead of your pharmacy benefits. These can include drugs that must be given to you by a health care provider. These drugs are often given to you in a hospital, doctor’s office or health care setting. Examples of these drugs are contraceptive implants and chemo infusion. If you are taking or prescribed a drug that is not on your plan's Drug List, call the number on your member ID card to see if the drug may be covered by your medical plan.
Nearby Pharmacies and Home Delivery
BCBSTX has a broad network of contracting pharmacies. To use your benefits, simply find a local contracting pharmacy and show your member ID card.
Preferred Pharmacy Network (PPN)
- Some members may have a Preferred Pharmacy Network as part of their prescription drug benefit.
- If included in your benefits, be sure to fill your prescriptions at these pharmacies.
When you visit a preferred pharmacy, you’ll get the lowest copay or coinsurance amount.
Find a PPN
- You can find preferred pharmacies on myprime.com by using the "preferred" filter.
Based on your benefit:
- You may be able to fill up to a 90-day supply of prescription drugs at these preferred pharmacies.
- For your convenience, you can switch to the home delivery service.
Home delivery orders can be completed online or over the phone in the comfort of your home.
Starting Jan. 1, 2020, pharmacists can bill you for professional services (not for dispensing drugs). This includes in-depth consultations. These services would be covered under your medical benefits. The amount you pay would be the same as seeing a specialist, based on your benefits.
Special Requirements or Limits
- For some drugs, you may need to meet certain criteria before your prescription drug coverage may be approved.
- Members using a specialty drug to treat a complex or rare condition may need to follow the specialty program requirements.
- Some drugs may have limits on how much medicine can be filled per prescription or in a given time span.
Review available resources such as frequently asked questions, a glucose meter offer and pharmaceutical care management program information.
See your benefit materials for details on prescription drug benefits. If you have questions about your benefits, call the number on your member ID card.