A drug list is a list of drugs available to Blue Cross and Blue Shield of Texas members. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. These prescription drug lists have different levels of coverage, which are called "tiers." Generally, how much you pay out of pocket for a prescription drug will be less if you choose a drug that is a lower tier.
Your doctor should consult the Drug List when prescribing drugs for you. This may help lower your out-of-pocket costs.
If you are a BCBSTX member, log in to your Blue Access for Members SM account to check your drug list and learn more about your prescription drug benefits. Be sure to review your benefit materials for details. If you have any questions about your prescription drug benefits, call the number listed on your member ID card.
Please note: Health plans may administer medical and pharmacy coverage separately for select drugs. Some drugs are covered under your medical plan instead of your pharmacy benefits. These can include drugs that must be given to you by a health care provider. These drugs are often given to you in a hospital, doctor’s office or health care setting. Examples of these drugs are contraceptive implants and chemo infusion. 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 medical plan.
Your prescription drug benefits through BCBSTX are based on a Drug List, which is a list of drugs considered to be safe and cost-effective.
To search for a drug name within the PDF Drug List document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking for and click on Search.
View your current drug list effective January 1, 2024:
Starting January 1, 2024, some changes will be made to the prescription drug benefit. Review the 2024 changes.
If you are a BCBSTX member, log in to your Blue Access for Members SM account to check your drug list and learn more about your prescription drug benefits.
You, your prescribing health care provider, or your authorized representative, can ask for a Drug List exception if your drug is not on (or is being removed from) the Drug List. To request this exception, you, your prescriber, or your authorized representative, will need to send BCBSTX documentation. To begin this process, you or your prescribing health care provider can call the number on your ID card for more information or fill out and submit the Prescription Drug Coverage Exception form . BCBSTX will let you, your prescriber (or authorized representative) know the benefit coverage decision within 72 hours of receiving your request. If the coverage request is denied, BCBSTX will let you and your prescriber (or authorized representative) know why it was denied and may advise you of a covered alternative drug (if applicable). You can also appeal the benefit determination.
If you have a health condition and failure to take the medication may pose a risk to your life, health or keep you from regaining maximum function, or your current drug therapy uses a non-covered drug, you, your prescriber, or your authorized representative, may be able to ask for an expedited review process. BCBSTX will let you, your prescriber (or authorized representative) know the coverage decision within 24 hours of receiving your request for an expedited review. If the coverage request is denied, BCBSTX will let you and your prescriber (or authorized representative) know why it was denied and may advise you of a covered alternative drug (if applicable). Call the number on your ID card if you have any questions. You can also appeal the benefit determination.
Your prescripti on drug benefits through BCBSTX may be based on the Basic Drug List, Basic Annual Drug List, Enhanced Drug List or the Enhanced Annual Drug List. These drug lists are a list of drugs considered to be safe and effective.
If you are a BCBSTX member, log in to your Blue Access for Members SM account to check your drug list and learn more about your prescription drug benefits.
View your drug list effective January 1, 2024:
Note: The 2024 drug lists may not apply for all members. Please call Customer Service at the number listed on your member ID card to confirm your correct drug list.
Note: The 2024 drug lists may not apply for all members. Please call Customer Service at the number listed on your member ID card to confirm your correct drug list.
Starting January 1, 2024, some changes will be made to the prescription drug benefit. Review the 2024 changes.
These drug lists' coverage ended December 31, 2023, with the exception of a plan with an off-cycle 2024 renewal date. Check your benefit materials for details.
Starting January 1, 2023, some changes were made to the prescription drug benefit. Review the 2023 changes.
You, your prescribing health care provider, or your authorized representative, can ask for a Drug List exception if your drug is not on (or is being removed from) the Drug List. To request this exception, you, your prescriber, or your authorized representative, will need to send BCBSTX documentation. To begin this process, you or your prescribing health care provider can call the number on your ID card for more information or fill out and submit the Prescription Drug Coverage Exception form . BCBSTX will let you, your prescriber (or authorized representative) know the benefit coverage decision within 72 hours of receiving your request. If the coverage request is denied, BCBSTX will let you and your prescriber (or authorized representative) know why it was denied and may advise you of a covered alternative drug (if applicable). You can also appeal the benefit determination.
If you have a health condition and failure to take the medication may pose a risk to your life, health or keep you from regaining maximum function, or your current drug therapy uses a non-covered drug, you, your prescriber, or your authorized representative, may be able to ask for an expedited review process. BCBSTX will let you, your prescriber (or authorized representative) know the coverage decision within 24 hours of receiving your request for an expedited review. If the coverage request is denied, BCBSTX will let you and your prescriber (or authorized representative) know why it was denied and may advise you of a covered alternative drug (if applicable). Call the number on your ID card if you have any questions. You can also appeal the benefit determination.
Note: The 2024 drug lists may not apply for all members. Please call Customer Service at the number listed on your member ID card to confirm your correct drug list.