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Pharmacist Healthcare Services

December 26, 2019

Effective 1/1/2020, there’s new Texas legislation regarding services provided by a pharmacist. Accordingly, Blue Cross and Blue Shield of Texas (BCBSTX) will reimburse a pharmacist for services within the scope of their license for fully insured members. These services include patient counseling, medication management that has been delegated by a physician, or other services that could also be provided by a physician, advanced nurse practitioner or a physician assistant.

These services would be subject to the member’s specialist cost share payment. Traditional roles such as dispensing of drugs and basic clarifications about drugs will not be included.

It is important to check eligibility and benefits before rendering services. This step will help determine if benefit prior authorization is required for a member. It will also help determine coverage status, applicable copayment, coinsurance and/or deductible amounts. Refer to the Eligibility and Benefits section on BCBSTX’s provider website for additional related resources.

Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.