When viewing your drug list, you might find letters in the additional requirements column. If your drug has an additional requirement, talk with your doctor. Here's what those letters mean:
Prescription Drugs
Small Group Benefit Changes
If you get your Blue Cross and Blue Shield of Montana health care coverage through your job, you may have changes to your prescription and pharmacy benefits.1 Check if these changes impact you. For coverage details, go to your member account.
Prescription Benefit Changes
The drug lists are assessed and updated often. Some prescription drugs on your list:
- May move to a higher or lower drug tier.
- May be added to or removed from the drug list.
- May have new additional requirements.
Drug List for Metallic Plans
Here’s your for coverage that renews or starts on or after January 1, 2026.
This coverage will end December 31, 2025, with the exception of a plan with an off-cycle 2026 renewal date. Check your benefit materials for details.
If you are taking or prescribed a drug that is not on your plan’s drug list, call the number on your member ID card to see if the drug may be covered by your plan’s medical benefits.
Preventive Drug List for Select Metallic High-Deductible Health Plans with Health Savings Accounts
Here's your $0 HDHP-HSA Preventive Drug List . This applies only for the following plans: Blue Preferred Gold PPOSM 135, Blue Preferred Gold PPOSM 123, Blue Preferred Gold PPOSM 101, Blue Preferred Silver PPOSM 136, Blue Preferred Silver PPOSM 127, Blue Preferred Silver PPOSM 122, Blue Preferred Silver PPOSM 101, Blue Preferred Bronze PPOSM 134, Blue Focus Gold POSSM 101, Blue Focus Silver POSSM 101, Blue Focus Silver POSSM 003 and Blue Focus Bronze POSSM 002.
Drug List Information
Prescriptions with Requirements
PA: Prior Authorization
A medicine may need to be pre-approved before it can be covered by your plan.
ST: Step Therapy
You may need to try a more cost-effective drug first before other drugs may be covered.
DL: Dispensing Limits
You may only be able to get a certain amount of your drug at one time.
Managing Your Prescriptions: What You Can Do
Talk with your doctor about your next steps. Your doctor or pharmacist can answer questions or concerns you may have about your prescribed medications. Pharmacy selections and your care are always between you and your doctor.
- Lower Cost Alternatives
- Drug Options
- MedsYourWay
- Prescription Updates
- In-Network Pharmacies
- Value Pharmacies
More to Know: Prescription Benefits
Prescription Drug List Tiers
Your health plan’s prescription drug list has many levels of coverage, called member payment tiers. Your pharmacy benefit has up to 6 payment tiers.
Most often, the lower the tier, the lower your out-of-pocket costs will be for the drug.
You could be paying more – or less – for your drug based on the tier.
Medical & Pharmacy Benefits
Some medications may be covered under your health plan’s medical benefits instead of your pharmacy benefits.
- Medical benefits: Medicine given to you by a health care professional in a hospital, office or health care setting.
- Pharmacy benefits: Prescribed medicines you can take on your own.
Drug Coupons
You may want to use a drug manufacturer’s coupon or copay card to pay for a covered prescription drug.
If you do, this amount will not apply to your plan deductible or out-of-pocket maximum, unless it is a permitted third-party cost sharing payment.
1 Members with a health plan provided through their employer will see these changes on their plan renewal date, unless otherwise listed.
2 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. 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 Value Participating Pharmacy and Participating Pharmacy Network pricing isn’t available for 100% cost-sharing plans.
4 Changes may be made to in-network pharmacies in the future.
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, which administers the pharmacy benefit management services for your plan.
Prime Therapeutics LLC is a separate company contracted by Blue Cross and Blue Shield of Montana to provide pharmacy solutions. Blue Cross and Blue Shield of Montana, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC. MyPrime.com is a pharmacy benefit website offered by Prime Therapeutics LLC.