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 a pharmacy plan design that encourages cost-effective drug selection while offering financial flexibility to our participants.

The three-tier pharmacy copay program encourages participants to choose medications that are less costly but equally effective. The program retains the participants' freedom of choice because benefits will still be available for nearly all branded prescription drugs.

By using generic medications or drugs on the preferred brand-name drug list, participants will be able to obtain those medications that are high quality and cost-effective. Benefits will be available for nearly all branded prescription drugs, with generic medications having the lowest copay and non-preferred brand-name drugs having the highest copay.

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

Generic drugs are available at the lowest 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 majority of high-quality branded drugs.

Non-preferred brand-name drugs have the highest copay. 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.

As a participant with a three-tier pharmacy copay you will receive a list of preferred brand-name drugs to help with your prescription drug choices.

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