Individual Health Insurance Plans Preferred Drug List (PDF, 27kB)

Three-Tier Pharmacy Copay
To help manage increasing prescription drug costs, Blue Cross and Blue Shield of Texas has implemented a pharmacy program that encourages cost-effective drug selection while offering financial flexibility to our participants.

The three-tier pharmacy copay program design encourages participants to choose medications that are less costly but equally effective. The program retains the participants' choice because benefits will still be available for nearly all branded prescription drugs. By using generic drugs or drugs on the preferred brand-name drug list, participants will be able to obtain medications that are high quality and cost-effective.

How It Works
The program design includes three-tiers of medications. The three tiers are comprised of:

Generic drugs are the most affordable drugs and offer participants the lowest available copay. Generic drugs are pharmaceutically and therapeutically equivalent to brand-name drugs.

Preferred brand-name drugs are available at a 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 have the highest copay. The non-preferred brand-name drug tier includes a small number of therapeutic drug categories. Non-preferred brand-name drugs may not offer clinical or cost advantages over other drugs in the same therapeutic category.

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* Texas Department of Insurance Form: PPO-SELCHOICE-3-OLC-2