Prescription Drug Benefits

BCBSTX offers three-tier and four-tier pharmacy copay plan designs. These plan designs offer you the opportunity to save money by choosing prescription medications that are less costly but equally effective. The plan designs retain your freedom of choice because benefits will still be available for nearly all branded prescription drugs.

The three-tier pharmacy copay plan design includes three tiers of medications that are comprised of:

• Generic Drugs – Generic drugs are the most affordable drugs and offer you the lowest available copay. Generic drugs are pharmaceutically and therapeutically equivalent to brand-name drugs.
• Preferred Brand-name Drugs – Preferred brand-name drugs are available at a slightly higher copay than generic drugs. The preferred brand-name drug tier consists of the vast majority of high-quality branded drugs.
• Non-preferred Brand-name Drugs – Non-preferred brand-name drugs have the highest copay. Non-preferred brand-name drugs may not offer clinical or cost advantages over other drugs in the same therapeutic category.

The four-tier pharmacy copay plan design includes four tiers of medications that are comprised of:

• Generic Drugs – Generic drugs are the most affordable drugs and offer you the lowest available copay. Generic drugs are pharmaceutically and therapeutically equivalent to brand-name drugs.
• Preferred Brand-name Drugs – Preferred brand-name drugs are available at a slightly higher copay than generic drugs. The preferred brand-name drug tier consists of the vast majority of high-quality branded drugs.
• Non-preferred Brand-name / Preferred Specialty Drugs – Non-preferred brand-name drugs may not offer clinical or cost advantages over other drugs in the same therapeutic category. Preferred specialty drugs have demonstrated clinical or cost advantages over non-preferred specialty drugs.
• Non-preferred Specialty Drugs – Non-preferred specialty medications may not offer clinical or cost advantages over other drugs in the same therapeutic category.

Not all medications have a therapeutic equivalent on the generic or preferred list. Check with your pharmacist or your physician to see if a substitute is available. Coverage for specific services will depend on your benefits program. Be sure to read your Evidence of Coverage or Benefits Booklet for further details on your program.