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INDIVIDUAL & FAMILY

2025 Prescription Drug Changes

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 check this page often for any changes to your drug list.

Man at a pharmacy speaking with a pharmacist.

Prescription Changes

Understand How Your Prescription Drugs May Change

Starting January 1, 2025, some prescription drugs:

  • May move to a higher or lower drug tier
  • May be added to or removed from the drug list
  • May have new special requirements 

Your 2025 Drug Lists

Depending on your plan, you will either have a 6 Tier Drug List or a 4 Tier Drug List. The 2025 drug lists are for coverage that renews or starts on or after January 1, 2025.

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 not on your plan’s drug list, call the number on your member ID card to learn if the drug could be covered by your plan’s medical benefits.

 
Woman looking at medicine bottle in her hand.

Additional Requirements

Your Prescriptions May Require a Few Extra Steps

When reviewing your drug list, you might find letters in the additional requirements columns. Here's what they mean:

  • 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.
  • QL (dispensing or quantity limits) – You may only be able to get a certain amount of your drug at one time.

Talk with your doctor if your drug has an additional requirement.

Pharmacist smiling at a patient.

UNDERSTANDING TIERS

How Prescription Tiers Work

Your health plan’s prescription drug list has a few levels of coverage, called member payment tiers.

Depending on your plan, you’ll have 4 tiers or 6 tiers. Each tier has its own cost with lower tiers normally costing less. You can find your medicine's drug tier when you check the drug list.

SAVINGS

Ways To Save On Your Prescription

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

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Use in-network pharmacies

Your out-of-pocket costs are often lower at an in-network pharmacy. 

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Ask about lower-cost options

You may have lower-cost alternatives, like generic drug options, if your drug moves to a higher tier.

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Visit a value pharmacy

Value pharmacies often have the highest savings.3 You can also fill up to a 90-day supply of most covered drugs in these stores or through home delivery.

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Use drug coupons

Drug manufacturer’s coupons or copay cards can help you lower your prescription's cost at check-out.4

Doctor talking to a young boy and his mom.

NEXT STEPS

Take These Steps With Your Doctor or Pharmacist

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.

Member Account

Review Your Pharmacy Benefits

Visit Blue Access for Members℠ to find in-network pharmacies, check your Rx benefits and more.

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 value pharmacy network pricing isn't available for 100% cost-sharing plans.

4 The amount of a drug manufacturer’s coupon or copay card used to pay for a covered prescription drug will not apply to your plan deductible or out-of-pocket maximum (unless it is a permitted third-party cost sharing payment).