Most people know to check to see if a doctor is in their health plan network before making an appointment. But you may not know to check another list if you start a new medication: the drug list.
The drug list is a list of drugs covered by your health plan. Drugs on the list are chosen based on their safety, cost and how well they work.
The list is updated when the market changes or new drugs are released. When you get a refill or a new prescription, make sure your doctor reviews the list.
The drug list can help you find out what you will pay out-of-pocket for prescription drugs. If a drug is not on the list, you may have to pay more.
Check the List
Sometimes, your health care providers will check the list when choosing a prescription for you. But you can also look it up yourself by logging in to your Blue Access for MembersSM (BAMSM) account. After you log in, go to the My Coverage tab and click on Prescription Drugs. If you have Prime as your pharmacy administrator, you can go to MyPrime.com and click on Find Medicines to see if a drug is on your list and get cost information.
What You Can Do if Your Drug Isn’t Covered
Because the drug list changes, a drug that was covered in the past may not be included on the list any more. That doesn’t mean you can’t get the drug, but it may mean you have to pay more for it.
There are two things you can do if a drug you take is no longer on the drug list:
1. Call the number on your member ID card. A customer service representative may be able to help.
2. Talk to your doctor to see if a different drug that is on the list could work for you.You can learn more about drug lists in the FAQ section of our site.
Source: How to Transfer a Prescription from One Pharmacy to Another, Pocket Sense, 2018
*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.