When viewing your drug list, you might find letters in the additional requirements column. If your drug has an additional requirement, talk with your doctor. Here's what those letters mean:
Small Group Benefit Changes for 2024
If you get your Blue Cross and Blue Shield of Illinois health care coverage through your job, changes to your prescription and pharmacy benefits may start on Jan. 1, 2024.1 Check if these changes impact you. For coverage details, go to your member account.
2024 Drug List
Starting January 1, 2024, 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
If you have an HMO plan and would like to find out if your medication is impacted2, you can review 2024 prescription drug list changes. If you have a non-HMO plan, you can check the 2024 drug list often for changes.
Drug List for Metallic Plans
Here are your 2024 drug lists for coverage that renews or starts on or after January 1, 2024:
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.
Preventive Drug List for Metallic High-Deductible Health Plans with Health Savings Accounts
Here's your $0 HDHP-HSA Preventive Drug List (This applies only for Blue PPO Gold℠ 113, Blue PPO Gold℠ 115, Blue PPO Silver℠ 133, Blue PPO Silver℠ 200, Blue PPO Bronze℠ 106, Blue PPO Bronze℠ 132, Blue PPO Bronze℠ 401, Blue Choice Preferred Gold PPO℠ 113, Blue Choice Preferred Gold PPO℠ 115, Blue Choice Preferred Silver PPO℠ 133, Blue Choice Preferred Silver PPO℠ 200, Blue Choice Preferred Bronze PPO℠ 106, Blue Choice Preferred Bronze PPO℠ 132, Blue Choice Preferred Bronze PPO℠ 401, Blue Options Gold℠ PPO 200, Blue Options Silver℠ PPO 107 and Blue Options Silver℠ PPO 404 plans).
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.
Commonly Used Drugs No Longer Covered
Here's a list of some drugs that will no longer be covered as of January 1, 2024.3
If your prescription drug is on the list, you'll see other drug alternatives that may be options for you.
Drug List Information
Prescriptions with Requirements
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.
DL: Dispensing Limits
You may only be able to get a certain amount of your drug at one time.
Review New Dispensing LimitsManaging Your Prescriptions: What You Can 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
- Drug Options
- MedsYourWay®
- Prescription Updates
- In-Network Pharmacies
- Preferred Pharmacies
More to Know: Prescription Benefits
Prescription Drug List 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 2024 tier.
Medical & Pharmacy Benefits
Some medications may be covered under your health plan’s medical benefits instead of your pharmacy benefits.2
- Medical benefits: Medicine given to you by a health care professional in a hospital, office or health care setting.
- Pharmacy benefits: Prescribed medicines you can take on your own.
1 Members with a health plan provided through their employer will see these changes on their 2024 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 Changes may be made to in-network pharmacies in the future.
5 The preferred pharmacy network pricing isn’t available for 100% cost-sharing plans or HMO plans.
MedsYourWay is not insurance. It is a drug discount card program that compares the drug discount card price for an eligible medication at participating pharmacies to the member’s benefit plan cost share amount and then applies the lower available price. Eligible medications are subject to change, prescription prices may vary by location and not all pharmacies participate. MedsYourWay is administrated by Prime Therapeutics, LLC, which administers the pharmacy benefit management services for your plan.
Prime Therapeutics LLC is a separate company contracted by Blue Cross and Blue Shield of Illinois to provide pharmacy solutions. Blue Cross and Blue Shield of Illinois, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC. MyPrime.com is a pharmacy benefit website offered by Prime Therapeutics LLC.