Illustration Look Up Prescription Drugs

Look Up Prescription Drugs

Starting January 1, 2023, some prescription drugs:

  • May move to a higher or lower drug tier
  • May be added to or removed from the drug list
  • May have new special requirements   

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.

2023 Drug List

Here’s your 2023 drug list (for coverage that renews or starts on or after January 1, 2023):

HMO 6 Tier Drug List

HMO 4 Tier Drug List

Non-HMO 6 Tier Drug List

Non-HMO 4 Tier Drug List

$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.

  • Medical benefits: drugs covered under your medical benefits must be given to you by a health care professional in a hospital, office or health care setting.
  • Pharmacy benefits: drugs covered under your pharmacy benefits are prescribed medicines you can take on your own.

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.

Drugs with Additional Requirements

When reviewing your drug list, you might find letters in the additional requirements column, 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.

Illustration Prescription Drug Change

Prescription Drug Tiers

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.

Commonly Used Drugs No Longer Covered

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.

Find covered drug alternatives

Ways to Save

  • You can save money by using an in-network pharmacy. Your out-of-pocket costs are often lower at an in-network pharmacy.  
  • At a preferred pharmacy, you may pay the lowest copay or coinsurance.3  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 2023 network, visit myprime.com.

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

Things to Do

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.

  • Lower Cost Alternatives Ask about lower-cost alternatives if your drug moves to a higher tier.
  • Drug Options Review other options if your drug is no longer covered (often a covered generic or brand alternative may be available).
  • Prescription Updates Have an authorization request sent to us, or change your prescription, if your drug has an additional requirement.
  • Stay In-Network Order your prescriptions to be filled at in-network pharmacies.

 

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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.