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Blue Access for Members and quoting tools will be unavailable from 3am - 6am on Saturday, October 20.
We apologize for any inconvenience.
Blue Access for Members and quoting tools will be unavailable from 2am - 5am Saturday, October 20.
We apologize for any inconvenience.
Due to system maintenance, BAM may experience a brief outage between 6am and 10am CST on March 9, 2014.
Prescription drugs are an important part of your health care coverage. If you have prescription drug coverage through Blue Cross and Blue Shield of Texas (BCBSTX), we want to help you better understand your prescription drug coverage and options, including convenient services and any limitations. Here you'll find all the helpful information and forms you need.
This is only a brief description of some of the prescription drug benefits. Not all benefits are offered by all health plans. For more complete details, including benefits, limitations and exclusions, please refer to your benefit materials.
Use the downloadable forms below to file claims and request changes. Note: If the PDF forms are altered in any way, they will not be processed by Blue Cross and Blue Shield of Texas.
All the files below are available as PDFs. You will need the Adobe® Reader® to access these files, which you can download for free at Adobe's site .
A Drug List is a list of preferred drugs that are available to BCBSTX members. These drugs are considered to be safe and cost-effective. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. Within a Drug List, generally the lower the tier, the lower the cost of the drug. Generic drugs usually cost less than brand-name drugs, and this saves money.
Your prescription drug benefits through BCBSTX may be based on the Preferred 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.
Individual and Employer-offered Plans
The 2014 drug lists may not apply for all members. Please call customer service to confirm your correct drug list.
2014 Individual Plans and Small Group (SHOP) Plans (group size 1–50 members)
Coverage begins January 1, 2014
The Drug Lists below are used with BCBSTX health plans available through the Marketplace. In 2014, your prescription drug benefits through BCBSTX may be based on either a Standard Drug List or a Generics Plus Drug List. Prescription Drug Lists used with Marketplace plans have different tiers. Within a Drug List, generally the lower the tier, the lower the cost of the drug.
Want to know which Drug List your Marketplace plan uses? Check the charts below.
If your health plan includes BCBSTX prescription drug benefits, these are administered by Prime Therapeutics, our pharmacy benefits manager (PBM).
Visit Prime Therapeutics to:
Through Prime Specialty Pharmacy, you can have self-administered specialty drugs delivered directly to you or your doctor's office. Specialty medications include those used in the treatment of complex medical conditions. Examples include hepatitis C, hemophilia, multiple sclerosis and rheumatoid arthritis. They are often received by injection or infusion, but may be topical or taken by mouth.
If you have coverage through Blue Cross and Blue Shield of Texas, vaccinations may be covered under the medical benefit or the prescription drug benefit, based on your plan. Flu vaccinations can be conveniently administered at a pharmacy near you. Help protect you and your covered family members from the flu by getting the flu shot.
Please check your benefit materials for details and any necessary copays. Or, you can call the Pharmacy Program number on the back of your ID card.
More information is available in the pharmacy vaccine program member flier .