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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 Blue Access for Members^SM (BAM^SM) 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.

Prescription Drug List

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 encourages members to use drugs that are safe, work well and are cost effective.

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.

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.
You can find preferred pharmacies on myprime.com by using the "preferred" filter.

90-Day Supply

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.

Starting Jan. 1, 2020, pharmacists can bill you for professional services (not for dispensing drugs). This includes in-depth consultations. These services would be covered under your medical benefits. The amount you pay would be the same as seeing a specialist, based on your benefits.

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, a glucose meter offer and pharmaceutical care management program information.

See your benefit materials for details on prescription drug benefits. If you have questions about your benefits, call the number listed on your member ID card.

Frequently Asked Questions

Does my health plan cover my prescription medicine?

All our health plans include prescription drug coverage as an essential benefit. However, how much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the annual drug list.

Learn more about your prescription’s cost
What is a generic drug, and how can I find my generic drug options?

Generic drugs are prescription drugs that aren’t brand name. Even though they work the same as their brand name alternatives, they often cost less. Choosing generic drugs can help make your health care more affordable

Please speak with your doctor before deciding to switch your prescription drugs. They can help decide if a generic option may be a good fit for you.

Learn more about generic drugs
Where can I get my prescriptions filled?

Your prescriptions can be filled at most local pharmacies, though you may save more by using an in-network pharmacy. In some cases, you can have your long-term or maintenance medicines delivered right to your home.

To find an in-network pharmacy specific to your plan, log in to Blue Access for Members^SM and go to Pharmacy Tools. There, you can search for in-network pharmacies by ZIP code or city and state.

Last Updated: Oct. 16, 2023