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New Pharmacy Services Program Coming in May

April 22, 2026

Applies to All Groups, Individual & Family Markets*

In December, we announced the Pharmacy Match program. It makes members’ health care journeys easier for those living with complex, long-term or rare health conditions.

Pharmacy Match expands the pharmacy network available to Blue Cross and Blue Shield of Texas members. It also uses a dynamic, real-time referral process to match members with the best-fit pharmacy for filling their specialty prescriptions within hours.

Fully insured market segments included are:

  • Individual & Family Markets
  • Small Group
  • Blue Balance FundedSM
  • Mid-Market
  • Custom Fully Insured
  • Student Health
  • Grandfathered, Transitional and Closed plans

What’s new: New Pharmacy Match implementation dates have been confirmed for our fully insured plans.

  • May 1, 2026: “New starts” (definition below) to therapy (for any specialty drug therapeutic categories)
  • June 1, 2026: Members currently on specialty drug therapy in all therapeutic categories except autoimmune and hemophilia
  • July 1, 2026: Members currently on specialty drug therapy for autoimmune conditions
  • September 1, 2026: Members currently on specialty drug therapy for hemophilia

“New starts” are members who are initiating therapy (new authorization and/or prescription) and do not have claim evidence indicating active treatment, or an authorization start date, between March 15, 2026, and May 1, 2026.

For more information: As a reminder, self-funded groups with Prime Therapeutics® as their Pharmacy Benefit Manager can select Advocate+ Pharmacy Match. Contact your account representative at BCBSTX for more information about either program.

*This article, or a similar version, is being shared with employer groups in the Employer News newsletter or news alert. 

Blue Cross and Blue Shield of Texas makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them. 

Prime Therapeutics, LLC is a separate company Blue Cross and Blue Shield of Texas contracts with to provide pharmacy solutions. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

Last Updated: April 22, 2026