2020 Prescription Drug Changes for Employer-Offered “Metallic” Plans

If you get your Blue Cross and Blue Shield of Texas (BCBSTX) health care coverage through your job, changes to your 2020 pharmacy benefit program may start on January 1, 2020.

Check if any of these changes may impact your medications. Also learn how to get the most of your pharmacy benefits.

Look Up 2020 Prescription Drugs

Starting January 1, 2020, some prescription drugs:

  • Will move to a higher or lower drug tier
  • May be added to or removed from the drug list
  • Have new special requirements

If you’d like to see if your medication is impacted, you can review 2020 prescription drug list changes.

Tab One Drugs with Special Requirements

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Drugs with Special Requirements

If you see a mark in the additional requirements columns, here's what they mean:

  • PA (prior authorization) – A medicine may need to be pre-approved before it can be covered by your plan.
  • ST (step therapy) – You may need to try a more cost-effective drug first before other drugs may be covered.
  • QL (dispensing or quantity limits) – You may only be able to get a certain amount of your drug at one time. Review new dispensing limits.
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Tab Two Prescription Drug Tiers

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Prescription Drug Tiers

Your health plan’s prescription drug list has many levels of coverage, called payment level tiers.

Your pharmacy benefit has up to 6 payment level tiers.

Most often, the lower the tier, the lower your out-of-pocket costs will be for the drug.

  • Tier 6: Non-preferred specialty
  • Tier 5: Preferred specialty
  • Tier 4: Non-preferred brand
  • Tier 3: Preferred brand
  • Tier 2: Non-preferred generic
  • Tier 1: Preferred generic

Some brands may be in a generic tier and some generics may be in a brand tier.

Each tier has a different cost. You could be paying more – or less – for your drug based on the 2020 tier.

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Tab Three Drugs No Longer Covered

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Drugs No Longer Covered

Some drugs will no longer be covered in 2020.

Here are some commonly used drugs that are no longer covered and covered alternatives

Commonly Used Drugs That Will No Longer Be Covered as of january 1, 2020
GENERIC BRAND SPECIALITY
METAXALONE AURYXIA REXULTI COPAXONE
MUPIROCIN CREAM CHLORZOXAZONE SENSIPAR OMNITROPE
CIALIS SOOLANTRA XELJANZ XR
COLCHICINE SUBOXONE
COLCRYS TRADJENTA
FINACEA TROKENDI XR
MINIVELLE ULORIC
RANEXA
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2020 Drug List

Here’s your 2020 drug list (for coverage that renews or starts on or after January 1, 2020).

Please note:

  • Some drugs may be covered under your health care plan’s medical benefits instead of your pharmacy benefits.
  • Drugs covered under your medical benefit must be given to you by a health care provider.
  • If you are taking or prescribed a drug that is not on your plan’s drug list, call the number on your member ID card to see if the drug may be covered by your plan’s medical benefits.

Drug Coupons

If you use a drug manufacturer’s coupon or copay card to pay for a covered prescription drug, this amount will not apply to your plan deductible or out-of-pocket maximum.

Your Next Steps

Talk with your doctor about:

  • Lower-cost alternatives if your drug moves to a higher tier
  • Other options if your drug is no longer covered (often a covered generic or brand alternative may be available)
  • Sending an authorization request to us, or changing your prescription, if your drug has a new special requirement
  • Ordering your prescriptions to be filled at in-network pharmacies

Your doctor or pharmacist can answer questions or concerns you may have about your prescribed medications. Pharmacy selections and your care are always between you and your doctor.

Answers for Your Questions

Here are ways you can learn about your pharmacy benefits:

Visit Blue Access for MembersSM (BAMSM) to see in-network pharmacies and learn more.

Log in to BAM

See your plan materials for pharmacy and prescription plan information

See Plan Information

Call the number on the back of your member ID card

Contact Us

Footnotes

  1. Members with a health plan provided through their employer will see these changes on their 2020 plan renewal date, unless otherwise listed. ↵

  2. Coverage is based on the terms and limits of your plan. For some drugs, you must meet certain criteria before prescription drug coverage may be approved. Drugs that have not received U.S. Food and Drug Administration (FDA) approval are not covered. ↵

  3. Commonly used drugs that are no longer covered may not apply to all strengths/formulations. Third-party brand names are the property of their respective owners. ↵