2022 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 2022 pharmacy benefit program may start on January 1, 2022.1

Check if any of these changes may impact you. You can also learn how to get the most of your pharmacy benefits.

Look Up Prescription Drugs

Starting January 1, 2022, some prescription drugs:

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

To find out if your medication is impacted2, you can review 2022 prescription drug list changes.

Drugs with Additional Requirements

When viewing your drug list, 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.

Talk with your doctor if your drug has an additional requirement.

Prescription Drug Tiers

Your health plan’s prescription drug list has many levels of coverage, called member payment tiers. Your pharmacy benefit has up to 6 payment tiers.

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

You could be paying more – or less – for your drug based on the 2021 tier.

Commonly Used Drugs No Longer Covered

Here's a list of some drugs that will no longer be covered as of January 1, 2022.3

If your prescription drug is on the list, you'll see other drug alternatives that may be options for you.

Find covered drug alternatives.

2022 Drug List

Here’s your 2022 drug list (for coverage that renews or starts on or after January 1, 2022):

Drug List

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)

Please note:

  • Some drugs may be covered under your health 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.

Pharmacy Savings

You can save money by using an in-network pharmacy. Your out-of-pocket costs are often generally lower at an in-network pharmacy.

At a preferred pharmacy, you may pay the lowest copay or coinsurance.4 You may also fill up to a 90-day supply of most covered drugs in store or through home delivery.

To find all pharmacies in your 2022 network, visit myprime.com.

Please note, changes could be made to the pharmacies in the future.

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.

Things to Do

Talk with your doctor about your next steps:

  • Ask about lower-cost alternatives if your drug moves to a higher tier.
  • Review other options if your drug is no longer covered (often a covered generic or brand alternative may be available).
  • Have an authorization request sent to us, or change your prescription, if your drug has a new additional requirement.
  • Order 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 may learn about your pharmacy benefits:

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

See your plan materials for pharmacy and prescription plan information.

Call the number on the back of your member ID card.

1 Members with a health plan provided through their employer will see these changes on their 2022 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. Some benefit plans may have preventive drug benefits. This means you may pay a lower cost, as low as $0, for preventive care drugs. If your plan has preventive drug benefits, and coverage for your prescription changes, the amount you pay under the preventive drug benefit may also change. Some drugs may be covered under your medical plan instead of your pharmacy benefits.

4 The preferred pharmacy network pricing isn’t available for 100% cost-sharing plans. 1, 2021, some changes were made to the prescription drug benefit. View the 2021 changes.