Prescription Drug Lists

A drug, or formulary, list is a list of preferred drugs available to Blue Cross and Blue Shield of Texas (BCBSTX) members. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. These prescription drug lists have different levels of coverage, which are called "tiers." Generally, how much you pay out of pocket for a prescription drug will be less if you choose a drug that is a lower tier.

If you are a BCBSTX member, log in to your Blue Access for MembersSM account to 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 Pharmacy Program number on the back of your member ID card.

Prescription Drug Lists (Formularies) for Metallic Individual Plans

The drug lists below are used with your health plan if all of these apply to you:

  • You enrolled in a plan on your own (instead of through your employer) and
  • Your plan is a "metallic" health plan, which can include a Gold, Silver, Bronze, Multi-State or Catastrophic plan.

Your prescription drug benefits through BCBSTX is based on a Drug List, which is a list of drugs considered to be safe and cost-effective.

View your drug list effective January 1, 2017:

Starting January 1, 2017, some changes will be made to the prescription drug benefit. View the 2017 changes.

View your current drug list.

Starting January 1, 2016, some changes will be made to the prescription drug benefit. View the 2016 changes.

You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List (also known as a formulary). To request this exception, you, or your prescriber, can call the number on the back of your ID card to ask for a review. If you have a health condition that may jeopardize your life, health or keep you from regaining function, or your current drug therapy uses a non-covered drug, you, or your prescriber, may be able to ask for an expedited review process. BCBSTX will let you, and your prescriber, know the coverage decision within 24 hours after they receive your request for an expedited review. If the coverage request is denied, BCBSTX will let you and your prescriber know why it was denied and offer you a covered alternative drug (if applicable). Call the number on the back of your ID card if you have any questions.

Prescription Drug Lists (Formularies) for Grandfathered Individual Plans

Note: The 2016 drug lists may not apply for all members. Please call customer service to confirm your correct drug list.

The drug lists below are used with your health plan if all of these apply to you:

  • You enrolled in a plan on your own (instead of through your employer),
  • Your current BCBSTX policy was effective before January 1, 2014, and
  • Your plan is not a "metallic" health plan.

Your prescription drug benefits through BCBSTX may be based on one of two different drug lists:

  • A Standard Drug List is a list of preferred drugs which are considered to be safe and cost-effective.
  • A Generics Plus Drug List is a smaller version of the Standard Drug List. It covers drugs for the major drug classes, but includes mostly generic drugs and fewer brand-name drugs.

View your current drug list:

Prescription Drug Lists (Formularies) for Employer-offered Plans: Large Group (51 or more)

Note: The 2016 drug lists may not apply for all members. Please call customer service to confirm your correct drug list.

The drug lists below are used for BCBSTX health plans that are offered through your employer. If your company has 51 or more employees, your prescription drug benefits through BCBSTX may be based on the Standard Drug List or the Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for all the major drug classes.

If you have a non-grandfathered health plan offered by your employer, some changes may be made to your prescription drug benefit through BCBSTX for 2017. See more information on these 2017 Prescription Drug Benefit Changes.

If you have a non-grandfathered health plan offered by your employer, some changes may be made to your prescription drug benefit through BCBSTX for 2016. See more information on these 2016 Prescription Drug Benefit Changes.

View your current drug list:

Prescription Drug Lists (Formularies) for Employer-Offered Metallic Plans: Small Group (1–50)

The Drug Lists below are used with BCBSTX "metallic" health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans.

If your company has 1-50 employees, your prescription drug benefits through BCBSTX are based on a Drug List, which is a list of drugs considered to be safe and effective.

View your drug list effective January 1, 2017:

Starting January 1, 2017, some changes will be made to the prescription drug benefit. View the 2017 changes.

View your current drug lists effective January 1, 2016:

Starting January 1, 2016, some changes will be made to the prescription drug benefit. View the 2016 changes.

You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List (also known as a formulary). To request this exception, you, or your prescriber, can call the number on the back of your ID card to ask for a review. If you have a health condition that may jeopardize your life, health or keep you from regaining function, or your current drug therapy uses a non-covered drug, you, or your prescriber, may be able to ask for an expedited review process. BCBSTX will let you, and your prescriber, know the coverage decision within 24 hours after they receive your request for an expedited review. If the coverage request is denied, BCBSTX will let you and your prescriber know why it was denied and offer you a covered alternative drug (if applicable). Call the number on the back of your ID card if you have any questions.

Want to know which Drug List your Texas Health Insurance Marketplace plan uses?

Prescription Drug Lists (Formularies) for Employer-offered Non-Metallic Plans: Small Group (1–50)

Note: The 2016 drug lists may not apply for all members. Please call customer service to confirm your correct drug list.

The formularies below are used for BCBSTX health plans that are offered through your employer. These health plans are not a "metallic" health plan and were effective before January 1, 2014.

If your company has 1–50 employees, your prescription drug benefits through BCBSTX may be based on the Standard Drug List or the Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for the major drug classes.

View your current drug list: