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Want to know if your medicine is covered under your plan? Our customer advocate Robert tells Vanessa where to find the list, how certain medications are chosen and how costs are determined.
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Originally published 12/11/2020; Video revised 6/2023
VANESSA: Hi, I'm Vanessa, and I'm meeting with a Blue Cross Blue Shield advocate to find out, how prescription drug lists work. I need to get a prescription filled, is there a way I can find out if my medicine is covered on my health plan?
BCBS ADVOCATE: You'll want to check your prescription drug list. If shows you the drugs covered under your plan. You can find it on your Blue Access for Members account or on myprime.com.
VANESSA: How are the drugs on that list chosen?
BCBS ADVOCATE: We base the list on recommendations from a committee of doctors and pharmacists throughout the US. The drugs are chosen based on their safety, their costs, and how well they work.
VANESSA: Do all members have the same drug list?
BCBS ADVOCATE: No, the list may vary based on whether you're on an individual or employer plan and your specific prescription drug benefit plan.
VANESSA: So how do I know how much my medicine will cost?
BCBS ADVOCATE: The drugs on the list are split into levels or tiers. Each tier my have a different cost. For example, a brand name drug may be in a higher tier and may cost more than a generic drug. You can use the list to see what tier your medicine falls under, and you can see how much you'll pay for drugs in each tier by visiting the Prescription Drug section of your Blue Access for Members account or by logging into myprime.com.
VANESSA:Thanks, I'll be sure to do that.
BCBS ADVOCATE: You're quiet welcome.
SPEAKER: For more information, call the number on your member ID card or visit our website at BCBSTX.com.
Hi Stephen, If you'd like to send us a private message our team can check on this for you. ~ Kayla
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