Blue Cross and Blue Shield of Texas covers most of the prescription drugs that your doctor may think you need. Your doctor will write a prescription so you can take it to the drugstore. Or they may send the prescription to the drugstore for you.
BCBSTX uses a list of drugs called a Preferred Drug List to help your doctor choose which drugs to give you. Certain drugs on this list need approval ahead of time or have limits based on medical necessity. In these cases, your doctor must ask for approval before you get the drug. Without approval, the drugs are not covered.
There are two kinds of drugs on the Preferred Drug List: brand-name and generic. A brand-name drug is a drug that is made by one company. A generic drug is the same drug without a brand. According to the U.S. Food and Drug Administration (FDA), compared to the brand drug, a generic:
- is chemically the same
- works the same in the body
- is just as safe and effective
- often costs much less
Generic drugs require the same testing as brand-name drugs. They are the same when it comes to strength, dose, form, route of administration or intended use. You can often buy brand and generic drugs at the same pharmacy.
Most of the time, brand-name drugs are covered only if no generic drug is available. BCBSTX may pay for brand-name drugs if:
- Your doctor writes on the prescription that you need the brand-name drug
- A brand-name drug is preferred by Medicaid.
Your doctor may suggest you get an over-the-counter (OTC) drug. You should still get a written prescription from your doctor because some OTC drugs will be covered. Take the prescription to the pharmacy to get it filled.
To find out if a drug is on our list, visit the formulary drug search. You can also call our Customer Advocate Department at 1-888-657-6061 (TTY: 711).