Blue Cross and Blue Shield of Texas' (BCBSTX) prescription drug benefits are administered by Prime Therapeutics, our pharmacy benefits manager.
Members can visit myPrime.com to:
- Search for prescription drugs
- Find a pharmacy
- Order refills online
- View formulary status
- Download forms and brochures
Prescription Drug List
BCBSTX pharmacy benefits include a list of preferred drugs (formulary) selected by BCBSTX based on clinical recommendations of the Prime Therapeutics National Pharmacy and Therapeutics committee. Drugs are recommended for addition to the Drug Lists after considering safety, efficacy, uniqueness, and cost. Physicians are encouraged to prescribe drugs in this list.
Members can search the online pharmacy directory to find a participating pharmacy near their home or office. Or, they can search for a pharmacy by name or ZIP code.
Mail Order Prescriptions
Members currently enrolled in the PrimeMail prescription drug program can submit refills online or by calling 1-833-715-0942. The service is available 24 hours-a-day, seven days-a-week, to refill, transfer a current prescription or get started with home delivery.
Some HMOs offer a 90-day supply benefit that can save time and money. With this program, members have the option of obtaining up to a 90-day supply of long-term (or maintenance) medications. The 90-day supply program is an option when using Prime's mail-order delivery.
Prior Authorization/Step Therapy Programs
The BCBSTX prior authorization/step therapy program is designed to encourage safe, cost-effective medication use. Most standard products plans include this program. Self-insured and custom fully insured groups offer a variety of these programs to help effectively manage their prescription drug benefit.
Pharmacy Benefits Tier Design Program
Your client's plan may include three-tier or four-tier pharmacy coinsurance and copay plan designs. These plan designs offer your client the opportunity to save money by choosing prescription medications that are less costly but equally effective. The plan designs retain freedom of choice because benefits will still be available for nearly all branded prescription drugs.
Women's Contraceptive Services
Our plans may cover certain contraceptive coverage as a benefit of membership. Coverage can vary depending on the type of plan enrolled in.
Prime Therapeutics LLC is a pharmacy benefit management company, contracted by BCBSTX to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.