Prescription drug benefits change for some members

Some BCBSM and BCN health plans now use our new, cost-effective drug list, called the Custom Select Drug List. As members move into these Affordable Care Act-compliant health plans, we’re encouraging them to talk with their physicians about medication options if they’ve been taking a prescription drug that may no longer be covered.

Although the Custom Select Drug List covers more than 3,000 prescription medications and certain preventive over-the-counter products, some drugs are not covered that may have been benefits under members’ previous drug plans.

The Custom Select Drug List groups medications into categories called tiers. Drugs that have proven track records and are the least expensive are in the lowest tiers to help protect members’ health and minimize their costs. If a drug is not on this list, it’s not covered. However, most excluded drugs are available in generic or over-the-counter forms.

We want members to be able to find covered medicines that meet their needs and help keep them healthy. You can check our member guide for an overview of the drugs covered by plans using the Custom Select Drug List. You can also review the full drug list.

What’s not covered

Drugs that are not on the Custom Select Drug List are not covered, even if a member is currently taking one. Some examples of drugs or drug categories not covered are:

• Brand-name drugs that have generic equivalents
• Drugs for erectile dysfunction, such as Viagra^® and Cialis^®
• Drugs for weight loss
• Drugs used for coughs and colds
• Most allergy medications, such as Allegra^®, Claritin^® and Zyrtec^®
• Most drugs to treat heartburn and acid reflux, such as Nexium^® and Dexilant^®
• Prenatal vitamins
• Compounded drugs, with some exceptions
• Certain habit-forming pain medications, such as Opana^®