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Prescription Drug

Prime Therapeutics is your prescription drug provider. Check the drug list below to see if your prescription drugs are covered. The drug list shows all covered medications. Choosing drugs from this list may save you money.

If you don't see your medication on the list check with your doctor for a lower-cost option that may work just as well and save you money!

Note that some drug classes may be excluded by some plans and therefore may not be covered under your pharmacy benefit. Your plan may have a different coverage level for specialty drugs. If you have questions about your coverage for specialty medications or your prescription drug benefit, call 1-800-521-2227 to talk to a Customer Advocate.

Where to Fill Your Prescriptions

To use your prescription drug benefits:

  • Find a contracting pharmacy near you and show them your member ID card.
  • Your pharmacy network consists of preferred and non-preferred pharmacies. You may pay an additional $5 for prescriptions at a non-preferred pharmacy.
  • For maintenance medications (medications you take on a regular basis), you can have a 90-day supply filled at a preferred (Tier 1) network pharmacy or have it sent right to your home through AllianceRx Walgreens Pharmacy. Log in to Blue Access for MembersSM to find the forms that specifically apply to your coverage under the "Forms and Documents" tab.

Estimate Prescription Drug Prices

Estimate how much your prescription drugs will cost and learn how to keep costs down. Log in to Blue Access for MembersSM and go to Prescription Drugs. This will take you to MyPrime.com, the member site of Blue Cross and Blue Shield of Texas' (BCBSTX)'s pharmacy benefit manager. Once you are in MyPrime.com, BEFORE you search for your medicines, click on "Find a Pharmacy". After you have found your pharmacy you can price your medication by clicking on the "select medicine" tab.

Medications That Must Be Preapproved

Under the Prior Authorization Program, your doctor has to get approval from Blue Cross and Blue Shield before your prescription drug plan will cover certain medications and drug categories. To check to see if preapproval is needed for your medication, Log in to Blue Access for MembersSM and go to Prescription Drugs. This will take you to MyPrime.com, the member site of BCBSTX’s pharmacy benefit manager. Once you are in MyPrime.com, click on the “Find Medicines” tab. From here you can enter your medication. You will see a notice if there are special requirements in order for the medication to be covered.

Medications That Require a Prescription History

The Step Therapy Program encourages safe, cost-effective medication use by requiring you to have a prescription history for a "first-line" medication before your benefit plan will cover a "second-line" drug. A first-line drug is recognized as safe and effective in treating a specific medical condition, as well as being a cost-effective treatment option. A second-line drug is a less-preferred or potentially more costly treatment option.

To see if any special requirements apply for your drug(s), log in to Blue Access for MembersSM and go to Prescription Drugs. This will take you to MyPrime.com, the member site of BCBSTX's pharmacy benefit manager.

Please note that recertification is required for step therapy.

Other Special Requirements and Limitations

Certain medications have special rules for coverage which may include:

  • Requirements around specialty medications used to treat complex medical conditions
  • Restrictions on how much of a drug you can get at once and how often you can get that prescription refilled at that quantity

Learn how these rules might affect you