Prescription Drug Program

Three-Tier Pharmacy Copay

To help manage increasing prescription drug costs, Blue Cross and Blue Shield of Texas is implementing a new pharmacy plan design that encourages cost-effective drug selection while offering financial flexibility to our policyholders.

The three-tier pharmacy copay plan design encourages policyholders to choose medications that are less costly but equally effective. The plan design retains the policyholders' freedom of choice because benefits will still be available for nearly all branded prescription drugs.

By using generic medications or drugs on the preferred brand-name drug list, policyholders will be able to obtain those medications that are high quality and cost-effective. Benefits will be available for nearly all branded prescription drugs, with generic medications having the lowest copay and non-preferred brand-name drugs having the highest copay.

After the calendar year deductible is met, the copayment amount will apply until the out-of-pocket maximum has been met. There are copay amounts on Pharmacy Plan VII.

How It Works

The plan design includes three-tiers of medications. The three tiers are comprised of:

Generic drugs are the most affordable drugs and offer policyholders the lowest available copay. Generic drugs are pharmaceutically and therapeutically equivalent to brand-name drugs.

Preferred brand-name drugs are available at a slightly higher copay than generic drugs. The preferred brand-name drug tier consists of the vast majority of high-quality branded drugs.

Non-preferred brand-name drugs have the highest copay. The non-preferred brand-name drug tier includes a small number of therapeutic drug categories. Non-preferred brand-name drugs may not offer clinical or cost advantages over other drugs in the same therapeutic category.