A drug, or formulary, list is a list of preferred drugs available to BCBSTX members. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. These prescription drug lists have different levels of coverage, which are called "tiers." Generally, how much you pay out of pocket for a prescription drug will be less if you choose a drug that is a lower tier.
The drug lists below are used with your health plan if all of these apply to you:
- You enrolled in a plan on your own (instead of through your employer) and
- Your plan is a "metallic" health plan, which can include a Gold, Silver, Bronze, Multi-State or Catastrophic plan.
Your prescription drug benefits through BCBSTX may be based on one of two different drug lists:
- A Standard Drug List is a list of preferred drugs which are considered to be safe and cost-effective.
- A Generics Plus Drug List is a smaller version of the Standard Drug List. It covers drugs for the major drug classes, but includes mostly generic drugs and fewer brand-name drugs.
These drug lists are effective January 1, 2015:
You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List (also known as a formulary). To request this exception, you, or your prescriber, can call the number on the back of your ID card to ask for a review. If you have a health condition that may jeopardize your life, health or keep you from regaining function, or your current drug therapy uses a non-covered drug, you, or your prescriber, may be able to ask for an expedited review process. BCBSTX will let you, and your prescriber, know the coverage decision within 24 hours after they receive your request for an expedited review. If the coverage request is denied, BCBSTX will let you and your prescriber know why it was denied and offer you a covered alternative drug (if applicable). Call the number on the back of your ID card if you have any questions.
Want to know which Drug List your Texas Health Insurance Marketplace plan uses?