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Prescription Drug Information

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 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.




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.

The 2014 drug lists may not apply for all members. Please call customer service to confirm your correct drug list.


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.

The Drug Lists below are used with BCBSTX health plans offered on and off the Texas Health Insurance Marketplace. These can include Platinum, Gold, Silver, Bronze, Multi-State and Catastrophic plans. Your prescription drug benefits through BCBSTX may be based on either a Standard Drug List or a 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. These Prescription Drug Lists have different tiers. Within a Drug List, generally the lower the tier, the lower the cost of the drug.

Metallic Individual Plans and Small Group (SHOP) Plans (group size 1–50 members)

Coverage begins January 1, 2014


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, the pharmacy benefits manager (PBM).

Visit Prime Therapeutics  to:

  • Search for prescription drugs
  • Find a pharmacy
  • Order mail service refills or new prescriptions online
  • View status of coverage for your drugs
  • Download forms and brochures
  • Get drug cost estimates
  • Learn more about drug side effects or interactions

BCBSTX has a broad network of contracting pharmacies. To use your benefits, simply find a contracting pharmacy close to you and present your member ID card.


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.


  • Prescription Drug Claim Form  (for Group Plan members)
    BCBSTX members with pharmacy benefits through an employer group insurance plan can use this form to request reimbursement for a prescription drug purchase. Members must submit the original pharmacy receipt with the completed form to Prime Therapeutics, the BCBSTX pharmacy benefits manager.
  • Prescription Drug Claim Form  (for Individual Plan members)
    BCBSTX members with pharmacy benefits through an individual insurance plan can use this form to request reimbursement for a prescription drug purchase. Members must submit the original pharmacy receipt with the completed form to Prime Therapeutics, the BCBSTX pharmacy benefits manager.
  • PrimeMail New Prescription Order Form  
    Members with BCBSTX prescription drug coverage can use this form to mail order new prescription maintenance medication. Mail the completed form to PrimeMail, and include the original prescription signed by your doctor.
  • PrimeMail Refill Prescription Order Form 
    Members with BCBSTX prescription drug coverage can use this form to mail order refills for prescribed maintenance medication.

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.

  • The flu shot covered under the prescription drug benefit can be conveniently administered at a participating vaccine network pharmacy. Just hand your ID card to the pharmacist.
  • To see a complete list of all participating pharmacies, log in to Blue Access for Members and select Prescription Drugs from the Quick Links section on the right-hand side. Or, you can call the number on the back of your ID card.
  • Before you go, be sure to confirm the location's participation and hours, vaccine availability and ask about any other age limits, restrictions or requirements that may apply.

More information is available in the pharmacy vaccine program member flier .

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