2024 Prescription Drug Changes for Employer-Offered “Metallic” Plans

If you get your Blue Cross and Blue Shield of Oklahoma (BCBSOK) health care coverage through your job, changes to your 2024 pharmacy benefit program may start on January 1, 2024.1

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, 2024, 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

2024 Drug List

Here’s your 2024 drug list (for coverage that renews or starts on or after January 1, 2024):

Drug List

$0 HDHP-HSA Preventive Drug List (This applies only for Blue Preferred Gold PPOSM 418, Blue Advantage Gold PPOSM 119, Blue Advantage Silver PPOSM 121 and Blue Preferred Silver PPOSM 419 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.

Icon Pharmacy Benefits

Drugs with Additional Requirements

When viewing your drug list, you might find letters in the additional requirements column. 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.

Icon Payments

Prescription Drug 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 2024 tier.

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 preferred 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 2024 network, visit myprime.com.

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

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.

Answers for Your Questions

Here are ways you may learn about your pharmacy benefits:

Log in to your Blue Access for MembersSM (BAMSM) to see in-network pharmacies and learn more

See your plan materials for pharmacy and prescription plan information.

Call the number on the back of your member ID card.

1 Members with a health plan provided through their employer will see these changes on their 2024 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.

The preferred pharmacy network pricing isn’t available for 100% cost-sharing plans.

Last Updated: Oct. 21, 2023