2023 Prescription Drug Changes for Employer-Offered “Metallic” Plans

If you get your Blue Cross and Blue Shield of Montana (BCBSMT) health care coverage through your job, changes to your 2023 pharmacy benefit program may start on January 1, 2023.¹

Check if any of these changes may impact you. You can also learn how to get the most of your pharmacy benefits. Be sure to come back to this page often for any changes to your drug list.

Look Up Prescription Drugs

Starting January 1, 2023, some prescription drugs:

• Will move to a higher or lower drug tier
• May be added to or removed from the drug list
• Have new additional requirements

2023 Drug List

Here’s your 2023 drug list (for coverage that renews or starts on or after January 1, 2023):

Drug List

$0 HDHP-HSA Preventive Drug List (This applies only for Blue Preferred Gold PPO^SM 135, Blue Preferred Gold PPO^SM 123, Blue Preferred Gold PPO^SM 101, Blue Preferred Silver PPO^SM 136, Blue Preferred Silver PPO^SM 127, Blue Preferred Silver PPO^SM 122, Blue Preferred Silver PPO^SM 101, Blue Preferred Bronze PPO^SM 134, Blue Focus Gold POS^SM 101, Blue Focus Silver POS^SM 101, Blue Focus Silver POS^SM 003 and Blue Focus Bronze POS^SM 002 plans)

Please note that some drugs may be covered under your health plan’s medical benefits instead of your pharmacy benefits.²

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

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.

Ways to Save

• You can save money by using an in-network pharmacy. Your out-of-pocket costs are often lower at an in-network pharmacy.
• At a value pharmacy, you may pay the lowest copay or coinsurance.³ You may also fill up to a 90-day supply of most covered drugs in store or through home delivery.

To find all pharmacies in your 2023 network, visit myprime.com.

Please note, changes could be made to the pharmacies in the future.

Drug Coupons

If you use a drug manufacturer’s coupon or copay card to pay for a covered prescription drug, this amount will not apply to your plan deductible or out-of-pocket maximum.

Things to 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 Ask about lower-cost alternatives if your drug moves to a higher tier.
• Drug Options Review other options if your drug is no longer covered (often a covered generic or brand alternative may be available).
• Prescription Updates Have an authorization request sent to us, or change your prescription, if your drug has an additional requirement.
• Stay In-Network Order your prescriptions to be filled at in-network pharmacies.

¹ Members with a health plan provided through their employer will see these changes on their 2023 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 (FDA) 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 pharmacy network pricing isn’t available for 100% cost-sharing plans.