Individual & Family:

See 2020 Prescription Drug Changes

If you bought a Blue Cross and Blue Shield of Texas (BCBSTX) health care plan, changes to your 2020 pharmacy benefit program may start on January 1, 2020.

Check if any of these changes may impact your medications. Also learn how to get the most of your pharmacy benefits.

Look Up 2020 Prescription Drugs

Starting January 1, 2020, some prescription drugs:

Will move to a higher or lower drug tier
May be added to or removed from the drug list
Have new special requirements

If you’d like to see if your medication is impacted¹, you can review 2020 prescription drug list changes.

Drugs with Special Requirements

If you see a mark in the additional requirements columns, here's what they mean:

PA (prior authorization) – A medicine may need to be pre-approved before it can be covered by your plan.
ST (step therapy) – You may need to try a more cost-effective drug first before other drugs may be covered.
QL (dispensing or quantity limits) – You may only be able to get a certain amount of your drug at one time. Review new dispensing limits.

Prescription Drug Tiers

Your health plan’s prescription drug list has many levels of coverage, called payment level tiers. Your pharmacy benefit has up to 6 payment level tiers.

Most often, the lower the tier, the lower your out-of-pocket costs will be for the drug.

Each tier has a different cost. You could be paying more – or less – for your drug based on the 2020 tier.

Drugs No Longer Covered

Here are some commonly used drugs that are no longer covered as of January 1, 2020² and covered alternatives.

Generic	Brand		Specialty
METAXALONE	AURYXIA	REXULTI	COPAXONE
MUPIROCIN CREAM	CHLORZOXAZONE	SENSIPAR	OMNITROPE
	CIALIS	SOOLANTRA	XELJANZ XR
	COLCHICINE	SUBOXONE
	COLCRYS	TRADJENTA
	FINACEA	TROKENDI XR
	MINIVELLE	ULORIC
	RANEXA

2020 Drug List

Here’s your 2020 drug list (for coverage that renews or starts on or after January 1, 2020).

Please note:

Some drugs may be covered under your health care plan’s medical benefits instead of your pharmacy benefits.
Drugs covered under your medical benefit must be given to you by a health care provider.
If you are taking or prescribed a drug that is not on your plan’s drug list, call the number on your member ID card to see if the drug may be covered by your plan’s medical benefits.

Drug Coupons

If you use a drug manufacturer’s coupon or copay card to pay for a covered prescription drug, this amount will not apply to your plan deductible or out-of-pocket maximum (unless it is a permitted third-party cost sharing payment).

Your Next Steps

Talk with your doctor about:

Lower-cost alternatives if your drug moves to a higher tier
Other options if your drug is no longer covered (often a covered generic or brand alternative may be available)
Sending an authorization request to us, or changing your prescription, if your drug has a new special requirement
Ordering your prescriptions to be filled at in-network pharmacies

Your doctor or pharmacist can answer questions or concerns you may have about your prescribed medications. Pharmacy selections and your care are always between you and your doctor.

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¹ Coverage is based on the terms and limits of your plan. For some drugs, you must meet certain criteria before prescription drug coverage may be approved.

² Commonly used drugs that are no longer covered may not apply to all strengths/formulations. Third-party brand names are the property of their respective owners. Drugs that have not received U.S. Food and Drug Administration (FDA) approval are not covered.