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Prescription Drugs

Find out what medications are covered and where you can get your prescriptions filled to maximize your benefits.

Check these documents to see if your prescription drugs are covered. The drug list consists of most preferred generic and many brand-name medications. Choosing drugs from this list may save you money.

If you don’t see your medication on the list check with your doctor for a generic or lower-cost option on the formulary that may work just as well and may save you money.

MedsYourWay®

MedsYourWay is a program that works with your Blue Cross and Blue Shield of Texas pharmacy benefit to automatically search for and find lower costs for your eligible medicines. All you need is your member ID Card.

How it Works

When you have your prescription filled at a participating, in-network retail pharmacy, simply show your ID Card to the pharmacist. MedsYourWay automatically compares the prices from participating drug discount cards against your cost share under your pharmacy benefit plan for eligible prescriptions.

The comparisons are done behind the scenes at the pharmacy. You will pay the lower available price and what you pay will apply to your yearly plan deductibles and/or out-of-pocket maximums.

MedsYourWay is not insurance. It is a drug discount card program that compares the drug discount card price for an eligible medication at participating pharmacies to the member’s benefit plan cost share amount and then applies the lower available price. Eligible medications are subject to change, prescription prices may vary by location and not all retail pharmacies participate. MedsYourWay is administered by Prime Therapeutics, LLC, which administers the pharmacy benefit management services for your plan.

Where to Fill Your Prescriptions

To use your prescription drug benefits:

  • Find a contracting pharmacy - (member will either have to login in or select to continue without logging in) near you and show them your member ID card.
  • For maintenance medications, you can have a 90-day supply sent right to your home. Your plan also allows you to fill a 90-day supply of your covered maintenance medication(s) at a contracting 90-day pharmacy. 

Estimate Prescription Drug Prices

You can estimate how much your prescription medications will cost and learn how to keep your costs down at MyPrime.

Prior Authorization Program

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

Check the Balanced Drug List or visit MyPrime to see if any special requirements apply for your drug(s).

Step Therapy Program

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 the Balanced Drug List or visit MyPrime to see if any special requirements apply for your drug(s).

If you are a current member and have recently gone through the Step Therapy Program for a particular drug, you do not have to complete a request again for that drug.

Other Prescription Drug Information

Certain medications have special rules for coverage which may include:

  • Higher out-of-pocket costs for name-brand or over-the-counter versions
  • Specialty medications used to treat complex medical conditions
  • Restrictions on how much of a drug you can get at once and how often you can get that prescription refilled at that quantity.

Glucose Meter Offer

We offer blood glucose meters to members with diabetes at no additional charge to help you manage your condition. See the glucose meter flier for more information about this offer and monitoring your blood glucose level.

Members with prescription drug coverage should check the Balanced Drug List to see which test strips for the meters offered are listed as preferred brands. Coverage and payment levels for non-preferred brand test strips may vary based on your pharmacy benefit plan.