Starting January 1, 2023, some prescription drugs:
If you have an HMO plan and would like to find out if your medication is impacted2, you can review 2023 prescription drug list changes. If you have a non-HMO plan, you can check the 2023 drug list often for changes.
Here’s your 2023 drug list (for coverage that renews or starts on or after January 1, 2023):
$0 HDHP-HSA Preventive Drug List (This applies only for Blue Choice Preferred Bronze PPOSM 502 plan)
Please note that some drugs may be covered under your health plan’s medical benefits instead of your pharmacy benefits.
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.
When reviewing your drug list, you might find letters in the additional requirements column, here's what they mean:
Talk with your doctor if your drug has an additional requirement.
Your health plan’s prescription drug list has many levels of coverage, called member payment tiers.
Some plans have up to 4 tiers and some plans have up to 6 tiers. Each tier has its own cost. Most often, the lower the tier, the lower your out-of-pocket costs will be for the drug.
When you get a prescription, you can look up the drug tier on your drug list.
Here's a list of some drugs that will no longer be covered as of January 1, 2023.2
If your prescription drug is on the list, you'll see other drug alternatives that may be options for you.
To find all pharmacies in your 2023 network, visit myprime.com.
Please note, changes could be made to the pharmacies in the future.
Talk with your doctor about your next steps. 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.
1 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.
2 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.
3 The preferred pharmacy network pricing isn't available for 100% cost-sharing or HMO plans.