2022 Drug List Change for BCBSTX Pharmacy Custom Fully Insured Groups

Aug. 11, 2021

2022 Drug List Change for BCBSTX Pharmacy Custom Fully Insured Groups

What’s happening: Blue Cross and Blue Shield of Texas (BCBSTX) will be moving our pharmacy benefit Custom Fully Insured groups (Large Groups and National Accounts) from an open drug list (Basic or Enhanced) to the more cost-effective and clinically appropriate managed drug list, Performance.

While the Performance drug list is more cost effective for groups, it also offers our members access to prescription drugs in all major drug categories.

This drug list transition will apply starting Jan. 1, 2022, and take effect upon the eligible Custom Fully Insured group’s 2022 renewal date.

Exceptions to this transition: All grandfathered, transitional and closed (renewal only) plans.

Why the transition: We continue to focus on a complete pharmaceutical management strategy of delivering lower overall health care costs, improved health outcomes and an unrivaled member experience.

This drug list transition supports this strategy by:

Reducing costs and helping control drug spend:

Managed drug lists can assist in managing both specialty and non-specialty drug spend. Strong cost management also helps offset the impact these cost drivers can have on premiums.
Providing health plans that allow access to cost-effective drug treatments helps keep costs down for our members.

Supporting maintained and improved health outcomes:

Studies have shown there is no evidence of increased medical costs when moving from an open to a managed drug list.
There is also no evidence of increased hospitalization rates, increased doctor visits or decreased adherence rates.

Managing a fully supported member experience:

Proactive transition communications will be key to reduce risk of surprises for members.
Benefit coverage collateral and digital resource tools are made available to our customers and members to help reinforce support of this drug list transition.
Members and their health care providers have 24/7 access to customer service and a coverage exception process to be used if necessary.

Member notices and support. Members may be impacted if they are:

Using prescription medications that are no longer covered
Using prescriptions that may still be covered but at a higher payment tier (non-preferred), or
Subject to new utilization management program criteria before prescription drug benefit coverage may be approved

Impacted members may receive a communication to alert them about the change at least 60 days prior to the transition. The letter will explain how the change may affect them. Members will be encouraged to talk with their health care provider(s) about their prescribed medications and if any changes in their drug therapy may be right for them.

Questions? Stay tuned for more information about this drug list transition, including member notices. If you have any questions, contact your BCBSTX account representative.

This information applies to members and groups with prescription drug benefits administered through Blue Cross and Blue Shield of Texas (BCBSTX).

BCBSTX contracts with Prime Therapeutics^® to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.