Prescription Drug Lists, Blue Cross and Blue Shield of Texas, Viagra Insurance Coverage Blue Cross.



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Prescription Drug Lists

A drug list is a list of drugs available to Blue Cross and Blue Shield of Texas (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.Your doctor should consult the Drug List when prescribing drugs for you. This may help lower your out-of-pocket costs.

If you are a BCBSTX member, log in to your Blue Access for Members SM account to 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 Pharmacy Program number on the back of your member ID card.

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 or Catastrophic plan.

Your prescription drug benefits through BCBSTX is based on a Drug List, which is a list of drugs considered to be safe and cost-effective.

To search for a drug name within the PDF Drug List document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and select Find/Search. Type in the word or phrase you are looking for and click on Search.

View your drug list effective January 1, 2018:

  • 2018 Drug List (6 Tier)
  • 2018 Drug List (5 Tier)*
  • Women’s Contraceptive Coverage List
  • ACA $0 Preventive Drug List

*Applies for Blue Advantage Plus Silver 102 – Three $0 PCP Visits only

Starting January 1, 2018, some changes will be made to the prescription drug benefit. View the 2018 changes.

You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List. 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.

Note: The 2018 drug lists may not apply for all members. Please call customer service to confirm your correct drug list.

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),
  • Your current BCBSTX policy was effective before January 1, 2014, and
  • Your plan is not a “metallic” health plan.

Your prescription drug benefits through BCBSTX may be based on one of two different drug lists:

  • Basic Drug List, which is a list of drugs considered to be safe and cost-effective.
  • Enhanced Drug List, which is a smaller version of the Basic Drug List. It covers drugs for the major drug classes, but includes mostly generic drugs and fewer brand-name drugs.

View your current drug list:

  • 2018 Basic Drug List
  • 2018 Basic Drug List Updates Summary
  • 2018 Enhanced Drug List
  • 2018 Enhanced Drug List Updates Summary

Note: The 2018 drug lists may not apply for all members. Please call customer service to confirm your correct drug list.

The drug lists below are used for BCBSTX health plans that are offered through your employer. If your company has 51 or more employees, your prescription drug benefits through BCBSTX may be based on the Basic Drug List, the Enhanced Drug List, the Performance Drug List or the Performance Select Drug List. These drug lists are a continually updated list of covered drugs.

View your current drug list:

  • 2018 Basic Drug List
  • 2018 Basic Drug List Updates Summary
  • 2018 5-Tier Basic Drug List
  • 2018 5-Tier Basic Drug List Updates Summary
  • 2018 Enhanced Drug List
  • 2018 Enhanced Drug List Updates Summary
  • 2018 5-Tier Enhanced Drug List
  • 2018 5-Tier Enhanced Drug List Updates Summary
  • 2018 Performance Drug List
  • 2018 Performance Select Drug List
  • Women’s Contraceptive Coverage List
  • ACA $0 Preventive Drug List

The Drug Lists below are used with BCBSTX “metallic” health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans.

If your company has 1-50 employees, your prescription drug benefits through BCBSTX are based on a Drug List, which is a list of drugs considered to be safe and effective.

View your drug list effective January 1, 2018:

  • 2018 Drug List (6 Tier)
  • Women’s Contraceptive Coverage List
  • ACA $0 Preventive Drug List

Starting January 1, 2018, some changes will be made to the prescription drug benefit. View the 2018 changes.

These drug lists’ coverage ended December 31, 2017, with the exception of a plan with an off-cycle 2018 renewal date. (Check your benefit materials for details.)

  • 2017 Drug List (3 Tier)
  • 2017 Drug List (5 Tier)

Starting January 1, 2017, some changes were made to the prescription drug benefit. View the 2017 changes.

You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List. 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.

Note: The 2018 drug lists may not apply for all members. Please call customer service to confirm your correct drug list.

The formularies below are used for BCBSTX health plans that are offered through your employer. These health plans are not a “metallic” health plan and were effective before January 1, 2014.

If your company has 1–50 employees, your prescription drug benefits through BCBSTX may be based on the Basic Drug List or the Enhanced Drug List. These drug lists are a continually updated list of covered drugs.

View your current drug list:

  • 2018 Basic Drug List
  • 2018 Basic Drug List Updates Summary
  • 2018 Enhanced Drug List
  • 2018 Enhanced Drug List Updates Summary
  • Women’s Contraceptive Coverage List
  • ACA $0 Preventive Drug List

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