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.
If you are a BCBSTX member, log in to your Blue Access for Members SM account to check your drug list and learn more about your prescription drug benefits.
View your current drug list effective January 1, 2024:
Starting January 1, 2024, some changes will be made to the prescription drug benefit. Review the 2024 changes.
These drug lists' coverage ended December 31, 2023, with the exception of a plan with an off-cycle 2024 renewal date. Check your benefit materials for details.
- 2023 Drug List
- 2023 In-Vitro Fertilization (IVF) Drug List (This applies only to those plans with in-vitro fertilization (IVF) coverage)
- $0 HDHP-HSA Preventive Drug List (This applies only for Blue Advantage Gold HMOSM 103, Blue Advantage Gold HMOSM 103-in vitro, Blue Advantage Silver HMOSM 101, Blue Advantage Silver HMOSM 101-in vitro, Blue Choice Gold PPOSM 103, Blue Choice Gold PPOSM 103-in vitro, Blue Choice Silver PPOSM 101 and Blue Choice Silver PPOSM 101-in vitro plans)
Starting January 1, 2023, some changes were made to the prescription drug benefit. Review the 2023 changes.
You, your prescribing health care provider, or your authorized representative, can ask for a Drug List exception if your drug is not on (or is being removed from) the Drug List. To request this exception, you, your prescriber, or your authorized representative, will need to send BCBSTX documentation. To begin this process, you or your prescribing health care provider can call the number on your ID card for more information or fill out and submit the Prescription Drug Coverage Exception form. BCBSTX will let you, your prescriber (or authorized representative) know the benefit coverage decision within 72 hours of receiving your request. If the coverage request is denied, BCBSTX will let you and your prescriber (or authorized representative) know why it was denied and may advise you of a covered alternative drug (if applicable). You can also appeal the benefit determination.
If you have a health condition and failure to take the medication may pose a risk to your life, health or keep you from regaining maximum function, or your current drug therapy uses a non-covered drug, you, your prescriber, or your authorized representative, may be able to ask for an expedited review process. BCBSTX will let you, your prescriber (or authorized representative) know the coverage decision within 24 hours of receiving your request for an expedited review. If the coverage request is denied, BCBSTX will let you and your prescriber (or authorized representative) know why it was denied and may advise you of a covered alternative drug (if applicable). Call the number on your ID card if you have any questions. You can also appeal the benefit determination.
