Sept. 7, 2016

2017 Pharmacy Benefit Changes for BCBSTX Non-metallic Plan Groups

Blue Cross and Blue Shield of Texas (BCBSTX) reviews the prescription drug benefit program annually to ensure the program is on target with current health care trends, while controlling prescription drug costs for our members. Based on our current review, some changes will be implemented for non-metallic plan groups with prescription drug benefits through BCBSTX and administered by Prime Therapeutics.

Beginning Jan. 1, 2017, these pharmacy benefit changes will be applied upon the group’s 2017 renewal/new plan effective date.*

  1. Formulary Changes and Formulary Name Changes

Two new drug lists, also known as a formulary, will be available in 2017. Additionally, the current Standard and Generics Plus Drug Lists’ names will change on Jan. 1, 2017.

Some pharmacy benefit plans will have a formulary change, while others will just have a drug list name change. Some members with a formulary change may be impacted by drugs changing from a preferred status to a higher non-preferred member payment level. Some members may also be impacted by a drug no longer being covered on the drug list. As a reminder, drugs that have not received U.S. Food and Drug Administration (FDA) approval are not covered.

                 2017 Drug List Names

  1. New Preferred Pharmacy Network

Beginning Jan. 1, 2017, upon a group’s renewal, some pharmacy benefit plans will include a Preferred Pharmacy Network. This network includes at least one major chain, a grocery chain and independent pharmacies, among others. These are the participating pharmacies in the 2017 Preferred Pharmacy Network:

When members fill a prescription for up to a 30-day supply of a covered prescription drug from a retail pharmacy that contracts to participate in the Preferred Pharmacy Network, they may pay the lowest copay/coinsurance amount. If members fill a prescription at a non-preferred in-network pharmacy, they may pay a higher copay/coinsurance amount.

For up to a 90-day supply of a covered prescription drug, members can either fill these prescriptions through the home delivery pharmacy service or at a retail pharmacy participating in the Preferred Pharmacy Network. Members will pay 3x copay of one 30-day prescription. A list of all participating pharmacies’ locations will be posted on the website once available.

Please see the list of changes for your reference.

Letters will be sent to impacted members who are affected by one or more of these changes that will explain how the change(s) will impact them. Members will be encouraged to talk with their doctor(s) about their prescribed medications and if any changes in their drug therapy may be right for them.

ASO groups are encouraged to make these same pharmacy benefit changes.

Stay tuned for more information about these pharmacy benefit changes, including member notifications and other communications. If you have any questions, please contact your BCBSTX representative.

*These pharmacy benefit changes apply for all fully insured standard plan groups that do not have a metallic plan policy. The changes will be implemented on the group’s 2017 renewal/effective date with the following exceptions:

Prime Therapeutics LLC is a pharmacy benefit management company. Blue Cross and Blue Shield of Texas (BCBSTX) contracts with Prime Therapeutics to provide pharmacy benefit management and other related services. BCBSTX, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.