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Prescription Drug Information

Prescription drugs are an important part of your health care coverage. If you have prescription drug coverage through Blue Cross and Blue Shield of New Mexico (BCBSNM), this information can help you and your doctor get the most from your prescription drug coverage.

This is only a brief description of some of the prescription drug benefits. Not all benefits are offered by all health plans. For more complete details, including benefits, limitations and exclusions, please refer to your benefit materials.

Drug Lists for Metallic Individual Plans

A drug list, or formulary, is a list of preferred drugs available to BCBSNM members. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the Drug List. Within a drug list, generally the lower the tier, the lower the cost of the drug. Your doctor should consult the Drug List when prescribing drugs for you.

The drug lists below are used with your health plan if all of these apply to you:

  • You enrolled in a plan on your own (instead of through your employer),
  • Your coverage began on or after January 1, 2014, and
  • Your plan is a "metallic" health plan, which can include a Platinum, Gold, Silver, Bronze, Multi-State or Catastrophic plan.

Your prescription drug benefits through BCBSNM may be based on one of two different drug lists:

  • A Standard Drug List is a list of preferred drugs which are considered to be safe and cost-effective.
  • A Generics Plus Drug List is a smaller version of the Standard Drug List. It covers drugs for the major drug classes, but includes mostly generic drugs and fewer brand-name drugs.

These drugs lists are effective January 1, 2014:

Want to know which Drug List your New Mexico Health Insurance Exchange plan uses?

Drug Lists for Grandfathered Individual Plans

A drug list, or formulary, is a list of preferred drugs available to BCBSNM members. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the Drug List. Within a drug list, generally the lower the tier, the lower the cost of the drug. Your doctor should consult the Drug List when prescribing drugs for you.

The drug lists below are used with your health plan if all of these apply to you:

  • You enrolled in a plan on your own (instead of through your employer),
  • Your current BCBSNM policy was effective before January 1, 2014, and
  • Your plan is not a "metallic" health plan.

Your prescription drug benefits through BCBSNM may be based on one of two different drug lists:

  • A Standard Drug List is a list of preferred drugs which are considered to be safe and cost-effective.
  • A Generics Plus Drug List is a smaller version of the Standard Drug List. It covers drugs for the major drug classes, but includes mostly generic drugs and fewer brand-name drugs.

These updated drugs lists apply starting January 1, 2014:

Drug Lists for Employer-offered Plans: Large Group (51 or more employees)

A Drug List, or formulary, is a list of preferred drugs that are available to BCBSNM members. These drugs are considered to be safe and cost-effective. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the Drug List. Within a drug list, generally the lower the tier, the lower the cost of the drug. Your doctor should consult the Drug List when prescribing drugs for you.

The drug lists below are used for BCBSNM health plans that are offered through your employer. If your company has 51 or more employees, your prescription drug benefits through BCBSNM may be based on either a Standard Drug List or a Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for the major drug classes.

These Drug Lists are effective starting January 1, 2014:

Drug Lists for Employer-offered Metallic Plans: Small Group (1–50 employees)

A Drug List, or formulary, is a list of preferred drugs that are available to BCBSNM members. These drugs are considered to be safe and cost-effective. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the Drug List. Within a drug list, generally the lower the tier, the lower the cost of the drug. Your doctor should consult the Drug List when prescribing drugs for you.

The Drug Lists below are used with BCBSNM "metallic" health plans that are offered through your employer. These can include Platinum, Gold, Silver, or Bronze plans.

If your company has 1–50 employees, your prescription drug benefits through BCBSNM may be based on either a Standard Drug List or a Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for the major drug classes.

These Drug Lists are effective starting January 1, 2014:

Want to know which Drug List your New Mexico Health Insurance Exchange plan uses?

Drug Lists for Employer-offered Non-Metallic Plans: Small Group (1–50 employees)

A Drug List, or formulary, is a list of preferred drugs that are available to BCBSNM members. These drugs are considered to be safe and cost-effective. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the Drug List. Within a drug list, generally the lower the tier, the lower the cost of the drug. Your doctor should consult the Drug List when prescribing drugs for you.

The formularies below are used for BCBSNM health plans that are offered through your employer. These health plans are not a "metallic" health plan and were effective before January 1, 2014.

If your company has 1–50 employees, your prescription drug benefits through BCBSNM may be based on either a Standard Drug List or a Generics Plus Drug List. The Generics Plus Drug List is a smaller version of the Standard Drug List. It includes mostly generic drugs and fewer brand-name drugs. The Generics Plus Drug List covers drugs for the major drug classes.

These updated drugs lists apply starting January 1, 2014:

Search Drug List and Find a Pharmacy

If your health plan includes BCBSNM prescription drug benefits, these are administered by Prime Therapeutics, the pharmacy benefits manager (PBM).

Visit Prime Therapeutics  to:

  • Search for prescription drugs
  • Find a pharmacy
  • Order mail service refills or new prescriptions online
  • View status of coverage for your drugs
  • Download forms and brochures
  • Get drug cost estimates
  • Learn more about drug side effects or interactions

BCBSNM has a broad network of contracting pharmacies. To use your benefits, simply find a contracting pharmacy close to you and present your member ID card.

Specialty Pharmacy Program

Your prescription drug benefit may include a specialty pharmacy program through Prime Therapeutics Specialty Pharmacy (Prime Specialty Pharmacy).

Specialty medications are:

  • Generally prescribed to treat serious or chronic conditions, such as multiple sclerosis, hemophilia, hepatitis C and rheumatoid arthritis
  • Typically given by injection, but may be topical or taken by mouth
  • Often require careful adherence to treatment plans and have special handling or storage requirements
  • Not always stocked by retail pharmacies

Specialty Drug List  — View the list of specialty medications. This list includes a reminder about coverage for self-administered specialty medications.

When you purchase specialty medications through Prime Specialty Pharmacy, you can have your self-administered specialty medications delivered directly to you, or to your doctor’s office. You also receive at no additional charge:

  • Support services for managing your drug therapy
  • Educational materials about your particular condition
  • Help with managing potential medication side effects
  • 24/7/365 customer service phone access

Note: Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC, a pharmacy benefit management company. BCBSNM contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSNM, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

Mail Service Program

PrimeMail®, the mail service pharmacy for members with BCBSNM prescription drug coverage, provides safe, fast and cost-effective pharmacy services that can save you time and money. With this program, you can obtain up to a 90-day supply of long-term (or maintenance) medications through PrimeMail. Maintenance medications are those drugs you may take on an ongoing basis to treat conditions such as high cholesterol, high blood pressure or diabetes.

Ordering Through PrimeMail

  • When you log in to Blue Access for Members and visit your Rx Drugs page, you can use the online order form, print an order form or ask that PrimeMail get in touch with your doctor to request a new prescription.

For more information about using mail service:

Prescription Drug Coverage Forms

Prescription Drug Resources

Other Prescription Drug Benefits

Vaccine Program

If you have coverage through Blue Cross and Blue Shield of New Mexico, vaccinations may be covered under the medical benefit or prescription drug benefit, based on your plan. Select vaccines can be conveniently administered at a pharmacy near you. These vaccines can help protect you and covered family members from illnesses such as the flu, pneumonia, shingles, rabies, hepatitis B, tetanus, diphtheria and pertussis.

To see which vaccines are covered under your plan, check your benefit materials for details and any necessary copays. Or, you can call the Pharmacy Program number on the back of your ID card.

  • The select vaccines covered under the prescription drug benefit are conveniently administered at a participating vaccine network pharmacy. Just hand your ID card to the pharmacist.
  • To see a complete list of all participating pharmacies, log in to Blue Access for Members and select Prescription Drugs from the Quick Links section on the right-hand side. Or, you can call the number on the back of your ID card.
  • Before you go, be sure to confirm the location's participation and hours, vaccine availability and ask about any other age limits, restrictions or requirements that may apply.

More information is available in the pharmacy vaccine program member flier .

Contact Us

For more information about BCBSNM prescription drug benefits:

  • Members — call the number printed on the back of your member ID card
  • Employers and Producers — call your BCBSNM account representative
  • Providers — call 1-800-325-8334, select option 5