Blue Cross and Blue Shield of Texas

Oct. 26, 2016

Member Notifications of 2017 Rx Changes in Small Group Metallic Plans

Notifications will be mailed this week to current 2016 Blue Cross and Blue Shield of Texas (BCBSTX) Small Group (metallic/QHP plan) members with a Q1 2017 renewal date impacted by a 2017 pharmacy benefit change, so they are informed before open enrollment begins in November.

The 2017 changes are in the following areas:

Updates to the participating pharmacies in the 2017 Preferred Pharmacy Network.
Drug list changes from a preferred brand (Tier 3) to a non-preferred brand (Tier 4) member payment level tier. Also, some generic drugs moved from a preferred generic (Tier 1) to a non-preferred generic (Tier 2) tier.
Certain products will no longer be eligible for coverage under the prescription drug benefit.
New Utilization Management Programs were added to the prescription drug benefit plan. These programs include prior authorization, step therapy and dispensing limits.

Please note: Members impacted by the CVS pharmacy network change will be sent a separate letter. See this article for more information – Jan. 1, 2017 Prime Pharmacy Network Change Member Communications to Be Released.

If you have any questions, contact your BCBSTX representative.

BCBSTX contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSTX and contracting pharmacies is that of independent contractors. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.