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BCBS TexasCommercial · Coverage · Pharmacy · TX · PharmacyHigh impact

Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2026 – Part 1

Effective date
Jan 1, 2026
Identified
Jan 12, 2026

Summary

6, 2025. Blue Cross and Blue Shield of Texas changed its pharmacy drug lists effective Jan. 1, 2026, with some drugs excluded from coverage and others moved to a higher out-of-pocket payment level, and it added new prior authorization programs and dispensing limits. Humira and Stelara coverage changed on most commercial drug lists starting Jan. 1, 2026, and the CivicaScript versions of capecitabine (50 mg and 500 mg) and dalfampridine (10 mg) became the only generic versions covered for members on all Individual & Family Market and commercial-group drug lists, starting Jan. 1, 2026, or upon renewal.

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What to do

Action · 6 steps
01Already effective Jan.
021, 2026: Providers should review the prescription drug list before prescribing, because some drugs may have been excluded from coverage or may have a new utilization management program requirement.
03If a patient needs a coverage exception or prior authorization request, use the forms in the provider website section for these requests.
04Humira and Stelara remain covered, subject to prior authorization, for groups on Open drug lists and on the ASO-only Balanced, Performance Select and Performance drug lists.
05Members may pay more for drugs moved from a preferred generic tier to a non-preferred generic tier, so advise them to review their benefit materials or call the number on their member ID card.
06Check current applicability of these changes before acting on them.

Original notice

Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2026 – Part 1
bcbstx.com · Always check the source before changing claims.
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Related changes

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