Oct. 20, 2021
Pharmacy Member Communications Mailing for Custom Fully Insured Groups with a 2022 Drug List Change
Applies to: Custom Fully Insured Large Groups and National Accounts
What’s happening: As previously communicated, Blue Cross and Blue Shield of Texas (BCBSTX) will be moving our pharmacy benefit Custom Fully Insured groups from an open drug list (Basic or Enhanced) to the more cost-effective and clinically appropriate managed drug list, Performance.
This drug list transition will apply starting Jan. 1, 2022, and take effect upon the eligible Custom Fully Insured group’s 2022 renewal date.
As a reminder, there are exceptions to this transition: All grandfathered, transitional and closed (renewal only) plans.
Member notices: Based on claims files, we will be mailing letters to affected members starting late October 2021. This will continue on a quarterly basis through late July 2022.
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
The letter will alert members of the change to their drug list coverage and provide them with the next steps they will need to take. One of these next steps is to visit a dedicated website, which will be posted when letters mail, where they can:
- Search for their medication(s) to check if they will remain covered, move to a higher or lower tier or be subject to new utilization management program requirements
- Review alternatives for commonly used drugs that will no longer be covered
- Get more information such as links to approval forms, the Performance drug list and other resources
Members are also 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? If you have any questions, contact your BCBSTX 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.
