2023 Prescription Drug Benefit Changes

If you have a non-grandfathered and non-metallic health plan offered by your employer, some changes may be made to your prescription drug benefit through Blue Cross and Blue Shield of Texas (BCBSTX).

Drug List Change

Starting January 1, 2023, or on your group’s 2023 renewal date, some member’s benefit plans will be based on a new drug list – Performance Annual Drug List. Today, these member’s plan benefits are based on the Basic Annual or Enhanced Annual Drug Lists.*

  • If this applies to you*, all covered prescription drugs are shown on the list. Drugs that are not shown are not covered.
  • Many drugs will remain covered on the new list. But, some drugs you use:

    • Will move to a higher or lower drug tier and out-of-pocket cost (copay/coinsurance amount)

    • May no longer be covered

    • Have new additional requirements (prior authorization, step therapy or dispensing limits) to meet first before coverage can be approved

  • If you’d like to see if your medication is impacted, you can review the prescription drug list changes.
  • You can also download a list of commonly used drugs that will no longer be covered and their alternatives.

Next Steps:

  1. If your drug will no longer be covered – Talk to your doctor about treatment options. Your doctor can ask for a drug list coverage exception. This includes any drugs you had a prior approval for but will no longer be covered.
  2. If your drug will have a higher out-of-pocket cost – Ask your doctor if a generic or lower-cost alternative drug may be right for you. It may cost you less.
  3. If your drug has new additional requirements to meet first – Talk to your doctor about the choices you have:

    • If your drug is now part of a prior authorization (PA) program, your doctor will need to submit pre-approval (also known as a prior authorization request) for coverage consideration. Review all PA programs that may apply.

    • If your drug is now part of a step therapy (ST) program, you may need to use a generic or lower-cost preferred drug first before coverage may be approved for another drug. Your doctor can submit a step therapy exception request if needed. Review all ST programs that may apply.

    • Your drug may have dispensing or quantity limits, such as how much medicine can be filled at a certain time. Your doctor can submit an exception request if you are prescribed more than the limit. Review the dispensing limits that may apply.

  4. You can review the full current Performance Annual Drug List today. This list may be changed only once a year.
  5. Some drugs must be given to you by a health care provider. These drugs are often covered under the medical plan and not listed on the prescription drug list. You can call us if you want to check coverage of a medication.

Remember: Treatment decisions are always between you and your doctor. Only you and your doctor can decide which medicine is right for you. Talk with your doctor, or pharmacist, about any questions or concerns you have about medicines you are prescribed. Coverage is subject to the terms and limits of your benefit plan. See your plan materials for details.

*Not all member’s benefits will make a drug list change. If your benefit plan is not changing drug lists, these changes will not apply. Check your benefit materials or call the customer service number on your Member ID card.