• What is a prescription drug list?
• Can I use a medication my doctor prescribes if it is not on the Drug List?
• What is a 4-Tier prescription drug plan?
• What is a specialty pharmacy drug?
• What are generic drugs?
• Who do I contact if I have questions about prescription drugs?
What is a prescription drug list?
The BCBSNM Drug List is a list of prescription drugs that are available to members at lower copayment levels. Drugs not on the list are still covered but require a higher copayment. The BCBSNM Pharmacy and Therapeutics Committee (made up of physicians and pharmacists) evaluates drugs for therapeutic uniqueness, safety, and cost before including them on the Drug List. Your physician has a copy of our Drug List and should consult it when making prescription drug decisions for you.
Can I use a medication that my doctor prescribes if it is not on the Drug List?
Yes, most drugs not listed are covered with BCBSNM's prescription drug plan. You have benefit coverage for most drugs, even if they are not on the Drug List. You will pay the highest copayment level.
What is a 4-Tier prescription drug plan?
Our 4-Tier prescription drug plan is similar to the 3-Tier plan, but includes a fourth tier for specialty medications. Make sure to have your specialty prescriptions filled at a participating specialty network pharmacy.
Your copayment for specialty medications is based on whether the drug you receive is a generic or a brand-name drug AND whether the drug is on the BCBSNM Drug List. See your Benefit Booklet or Prescription Drug Plan Rider for details, limitations, and exclusions.
| Tier 1=lowest copayment | You pay this amount when you receive a generic drug. |
| Tier 2=middle copayment | You pay this amount when you receive a brand-name drug that is on our drug list and no generic is available. |
| Tier 3=highest copayment | You pay this amount when you receive a brand-name drug that is not on our drug list. |
| Tier 4=specialty drug | You pay a copay or percentage based on your plan benefits. |
What is a specialty pharmacy drug?
Specialty pharmacy drugs are used to treat serious and/or chronic conditions such as multiple sclerosis, pulmonary hypertension, hepatitis, and rheumatoid arthritis. These medications are typically injectable and can be administered by a patient or family member. Members with health coverage that includes specialty pharmacy benefits must use a contracting specialty network pharmacy to fill these specific prescriptions.
Are generics as safe as brand-name drugs?
Yes. The U.S. Food and Drug Administration (FDA) must review and approve generic drugs before they are made available to the public. Plus, generic drugs must have the same active ingredients and be chemically equivalent to their compatible brand-name drugs, which have years of testing and clinical research behind them. Only generic drugs that have the same clinical effects and safety profile as the brand-name drug require substitution under BCBSNM plans.
What are generic drugs?
A generic drug is a version of a brand drug. According to the U.S. Food and Drug Administration (FDA), compared to the brand drug, a generic:
- is chemically the same
- works the same in the body
- is just as safe and effective
- meets the same standards set by the FDA
- often costs much less
Who do I contact if I have questions about prescription drugs?
You should discuss questions and concerns about drugs that you are taking with your physician. He or she can discuss whether a BCBSNM listed medication is appropriate for you. If you have any questions about your prescription drug benefits, call Customer Service at 1-877-357-7463.
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