Prescription Drug Benefits

Which Prescription Drugs Are Covered?*

The prescription drug list is a continually updated list of covered drugs. 

Choosing drugs from this list may save you money.

2025 drug list for current members: Performance Annual Drug List

2024 drug list for current members: Performance Annual Drug List

View the Performance Annual Drug List to check if your medicine(s) are covered. Review a list of drugs (as of Oct. 1, 2024) that will move to a higher payment tier or no longer be covered starting Jan. 1, 2025. The left column lists drug(s) moving to a non-preferred brand status or no longer covered.

Please call us at 1-877-325-2996 to verify prescription coverage. If you do not see your medication on the list, check with your doctor for a therapeutic alternative that might be right for you.

Preventive Drug Lists

• Preventive Contraceptive List
• ACA $0 Preventive Drug List
• Zero-Dollar Emergency-Use Medications

* Note that some drugs may be excluded from the drug list and some drugs may move to a higher payment level. The drugs that move to a higher payment level may still be covered but you will pay more. Drugs that are excluded will not be covered under your pharmacy benefit. Your plan may have a different coverage level for specialty drugs. If you have questions about your coverage for specialty medications or your prescription drug benefit, call 1-877-325-2996 to talk to a Customer Advocate.

Estimate Prescription Drug Prices

You can estimate how much your prescription medications will cost at MyPrime.

Visit MyPrime to find prices for your medications and learn how to keep costs down by utilizing the Performance Annual Drug List above for current members.

You can use our web and mobile tools to help manage your prescription drug benefits. With Blue Access for Members^SM or the BCBSTX App, you can check coverage, find in-network pharmacies, learn more about your medications, review your prescription claims history, get clinical review status and more.

Medications That Must Be Pre-Approved

Under the Prior Authorization Program, your doctor has to get approval from Blue Cross and Blue Shield before your prescription drug plan will cover certain medications and drug categories.

Check to see if pre-approval is needed for your medication.

Medications That Require a Prescription History

The Step Therapy Program encourages safe, cost-effective medication use by requiring you to have a prescription history for a "first-line" medication before your benefit plan will cover a "second-line" drug.

• A first-line drug is recognized as safe and effective in treating a specific medical condition, as well as being a cost-effective treatment option.
• A second-line drug is a less-preferred or potentially more costly treatment option.

Check to see if any special requirements apply for your medication.

If you are a current member and have recently gone through the Step Therapy Program, you do not have to complete it again.

Where to Fill Your Prescriptions

To use your prescription drug benefits:

• Find a contracting pharmacy near you and show them your ID card. (Select “Other BCBSTX Health Plans” and “Advantage Network” before starting your search.) Please note, CVS-owned pharmacies are excluded from your Blue Cross and Blue Shield pharmacy network.
• Some medicines may be eligible for the MedsYourWay^® drug discount card program. This program works with your pharmacy benefit to automatically find lower available costs. It compares drug discount card prices to your plan cost share amount. You’ll pay the lower available price and what you pay counts toward your plan deductible or out-of-pocket maximum.
• For maintenance (or long-term) medications, you can have up to a 90-day supply sent right to your home using the home delivery program. Your plan may also allow you to fill a 90-day supply of your covered maintenance medication(s) at a contracting pharmacy. Be sure to check your benefit materials to verify.

Log in to BAM to find the prescription drug forms that specifically apply to your coverage under the "Forms and Documents" tab. If you need help finding a pharmacy or forms, call 1-877-325-2996 to talk to a Customer Advocate.

Transferring Current Prescription(s) to Your New Pharmacy

• Over the phone or in person, ask your new pharmacy/pharmacist to contact your current pharmacy and transfer any remaining refills for you.
• You can find the pharmacy's phone number on the label of your prescription.
• Give the new pharmacy/pharmacist your prescription number, which is also on the label of your prescription.
• When you fill your prescription at your new pharmacy, be sure to bring your member ID card with you.
• To start using the home delivery program, sign in at myprime.com and follow the instructions to register.

Other Special Requirements and Limitations

Certain medications have special rules for coverage which may include:

• Higher out-of-pocket costs for name-brand drugs that have generic or over-the-counter versions
• Requirements around specialty medications used to treat complex medical conditions such as Hepatitis C and multiple sclerosis (MS)
• Restrictions on how much of a drug you can get at once and how often you can get that prescription refilled at that quantity

Learn how these special rules might affect you.