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Small Group Benefit Changes for 2025

If you get your Blue Cross and Blue Shield of Montana health care coverage through your job, changes to your prescription and pharmacy benefits may start on Jan. 1, 2025.1 Check if these changes impact you. For coverage details, go to your Blue Access for MembersSM account.

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2025 Drug List


Starting January 1, 2025, 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

Drug List for Metallic Plans

Here’s your 2025 Drug List  for coverage that renews or starts on or after January 1, 2025.

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.

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.

Drug List Information

Prescriptions with Requirements

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:

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PA: Prior Authorization

A medicine may need to be pre-approved before it can be covered by your plan.

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ST: Step Therapy

You may need to try a more cost-effective drug first before other drugs may be covered.

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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.

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 2025 tier.

Medical & Pharmacy Benefits

Some medications may be covered under your health plan’s medical benefits instead of your pharmacy benefits.2

  • 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 2025 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 Pharmacy Network pricing isn’t available for 100% cost-sharing plans.

4  Changes may be made to in-network pharmacies in the future.

Prime Therapeutics LLC provides pharmacy solutions for Blue Cross and Blue Shield of Montana. 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 owned and operated by Prime Therapeutics LLC.