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INDIVIDUAL & FAMILY

Your Pharmacy Benefits

Find your covered prescriptions, ways to save and next steps with your doctor or pharmacist. Already a member? Explore all of your plan's pharmacy benefits in your member account.

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A woman shows a pharmacist her perscription information on her phone.

Prescription Changes

Understand How Your Prescription Drugs May Change

Blue Cross and Blue Shield of New Mexico's drug lists are assessed and updated every year. Starting Jan. 1, 2025, some of your prescription drugs1:

  • May move to a higher or lower drug tier
  • May be added to or removed from the drug list
  • May have new special requirements. Review new dispensing limits.
An illustration demonstrating 6-tier and 4-tier drug lists

Drug Lists

Your 2025 Drug Lists and Tiers

The 2025 drug lists are for coverage that renews or starts on or after Jan. 1, 2025. Depending on your plan, you have either a:

Search the prescription drug list to find your medicine’s drug tier. Please note, some drugs may be covered by your plan's medical benefits.2

  • Medical benefits: drugs covered by medical benefits must be given to you by a health care professional in a health care setting.
  • Pharmacy benefits: drugs covered by pharmacy benefits are prescribed medicines you can take on your own.

Taking a drug not on your list? Review your medical drug benefit list or log in to your member account to search prescription drugs.

 
Illustration depicting a drug list example.

PRESCRIPTION COSTS

How Prescription Tiers Work

You’ll pay the cost of your prescription until you meet your plan’s annual deductible. Then, you’ll pay an out-of-pocket amount depending on your drug’s tier. When you get a prescription, you can look up the drug tier on your drug list. It will also show you if your drug has any additional requirements.

Some plans have 5 tiers and others have up to 6 tiers. Each tier has its own cost. Typically, the lower a tier, the lower the cost of the prescription. 

In-Network Pharmacies

Save Money With In-Network Pharmacies

When you pick up your prescriptions from a pharmacy that's in your network, you may save money. 

Search In-Network Pharmacies
 

Prescription Savings

Ways to Save Money on Your Prescriptions

Prescriptions can be expensive. You may be able to save on your drug or pharmacy costs. As always, check with your doctor or pharmacist to learn if these options may work for you.

Explore Ways to Save
Prescriptions and a BCBSMT ID card icon.

Use in-network pharmacies.

Your out-of-pocket costs are often lower when you get your prescriptions from an in-network pharmacy. 

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Keep your prescriptions updated.

Speak with your doctor about submitting an authorization request. Or, if your drug has an additional requirement or is no longer covered, ask to change your prescription.

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Get MedsYourWay® discounts.

MedsYourWay3 automatically applies drug discount card prices on eligible prescriptions. Just show your member ID card at an in-network pharmacy to learn if you could save.

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Ask about lower-cost options.

You may have lower-cost alternatives for your prescription, like generic drugs. Speak with your doctor about your options.

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Visit a preferred pharmacy.

At a preferred pharmacy4, you may pay the lowest copay or coinsurance. You may also fill up to a 90-day supply of most covered drugs in store or through home delivery.

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Opt for a 90-day supply.

Some prescriptions can be filled in a larger amount, just like you would buy in bulk from a grocery store. Depending on your medicine, you might be able to save time with a 90-day supply.5

 

Additional Requirements

Do You Have More Steps to Get Your Prescription?

1 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.

2 Drugs that have not received U.S. Food and Drug Administration approval are not covered. 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.

3 The preferred pharmacy network pricing isn't available for 100% cost-sharing plans.

4 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, a separate company providing pharmacy solutions for your plan.

5 Not all prescriptions can be filled in a 90-day supply and may need to be filled at select retail pharmacies or via home delivery. Based on your plan benefits, you may not save on your out-of-pocket costs but will spend less time going to the pharmacy.