PHARMACY AND PRESCRIPTION PLAN INFORMATION
Prescription drugs are a vital part of your health care coverage. If you have prescription drug coverage through Blue Cross and Blue Shield of Texas (BCBSTX), this information can help you and your doctor get the most from your prescription drug coverage.
If you are a BCBSTX member, log in to your Blue Access for MembersSM (BAMSM) account to 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 Pharmacy Program number on the back of your member ID card.
A drug list is a list of drugs that are covered under your prescription drug benefit. How much you pay out of pocket is determined by whether your drug is on the list and at what coverage level, or tier. A generic drug is often at the lower tier. See if your drug is covered.
Some prescription drug plans may require you to pay more if you fill a prescription for a brand name drug when a generic equivalent is available. This Member Pay the Difference Program encourages members to use drugs that are safe, work well and are cost effective.
If a drug is not on the drug list, call the number on the back of your ID card to see if the drug may be covered. Based on your benefit plan, you may have to pay more for a drug that is not on the drug list.
Nearby Pharmacies and Home Delivery
BCBSTX has a broad network of contracting pharmacies. To use your benefits, simply find a local contracting pharmacy and show your member ID card.
Preferred Pharmacy Network (PPN)
- Some members may have a Preferred Pharmacy Network as part of their prescription drug benefit.
- If included in your benefits, be sure to fill your prescriptions at these pharmacies.
When you visit a preferred pharmacy, you’ll get the lowest copay or coinsurance amount.
Based on your benefit:
- You may be able to fill up to a 90-day supply of prescription drugs at these preferred pharmacies.
- For your convenience, you can switch to the home delivery service.
Home delivery orders can be completed online or over the phone in the comfort of your home.
Special Requirements or Limits
- For some drugs, you may need to meet certain criteria before your prescription drug coverage may be approved.
- Members using a specialty drug to treat a complex or rare condition may need to follow the specialty program requirements.
- Some drugs may have limits on how much medicine can be filled per prescription or in a given time span.
Review available resources such as frequently asked questions and a glucose meter offer.
See your benefit materials for details on prescription drug benefits. If you have questions about your benefits, call the Pharmacy Program number on the back of your member ID card.