This article is intended for members enrolled in an individual health insurance plan.
No one wants to experience sticker shock at the pharmacy counter when picking up a prescription. If you have prescription drug coverage through Blue Cross and Blue Shield of New Mexico (BCBSNM), check your drug list before filling your prescription so you know your out-of-pocket costs before you go.
What Is a Drug List?
The BCBSNM drug list is a list of covered drugs that is updated regularly. The drug list is continually reviewed by a group of doctors and pharmacists.
Show this list to your doctor and/or pharmacist so he or she can see if a drug on the list will work for you. Depending on your benefit plan, you may have to pay more for, or pay all the cost of, a drug that is not on the drug list.
If you forget to bring a copy, you can pull it up on your phone by logging in to MyPrime.com.
What Are Drug Tiers?
Prescription drug lists have different levels of coverage, which are called payment tiers. Generally, if your doctor chooses a drug that is in a lower tier, your out-of-pocket costs will be less. It’s important for your doctor to consult the drug list when prescribing drugs for you. This may help lower your out-of-pocket costs.
What If My Doctor Prescribes a Drug That Is Not on the List?
If a drug is not on the drug list, call the number on the back of your ID card to see if the drug may be covered.
How Often Is the List Updated, and Where Do I Find a Copy of the Latest Version?
The drug list is updated annually. Log in to your Blue Access for MembersSM account to see the current drug lists and learn more about your prescription drug benefits.
Be sure to review your benefit materials for details. If you have any questions about your prescription drug benefits, call the customer service number on your member ID card and select the pharmacy option.
Prime Therapeutics, LLC, is a separate pharmacy benefit management company contracted by Blue Cross and Blue Shield of New Mexico (BCBSNM) to provide pharmacy benefit management and other related services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSNM and contracting pharmacies is that of independent contractors. BCBSNM, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.com is an online resource offered by Prime Therapeutics, LLC.