CommercialCoverageMedium impact
Pharmacy Program Quarterly Update Changes Effective July 1, 2025 – Part 1
BCBS Texas·TX · Pharmacy, Internal Medicine, Cardiology +4 more·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jan 12, 2026
Summary
Blue Cross Blue Shield of Texas is removing 16 brand-name drugs from its pharmacy formularies effective July 1, 2025, replacing them with generic equivalents or alternative medications. This affects multiple drug list tiers (Balanced, Performance, Performance Select, Basic, Enhanced) and applies only to TX ASO members on quarterly updates; annual plan members are not affected until January 1, 2026. Billing teams must prepare to handle prior authorization requests and patient appeals for affected medications.
Action Required
By June 15, 2025: Billing and clinical teams must review the complete list of excluded medications (Betimol, Cetraxal, Mesnex, Methotrexate Sodium injection, Morphine Sulfate oral solution, Namzaric, Nexium suspension, Nitrolingual, Ocaliva, Oxbryta tablets and suspension, Velphoro) and identify patients currently using these drugs. Create a communication plan to notify providers and patients of generic alternatives before July 1, 2025. Update pharmacy benefit verification tools and billing software to reflect the exclusions by June 30, 2025. Train clinical staff to advise patients to contact their prescribers for alternative medications and to be prepared to process prior authorization requests if providers request exceptions. Monitor claims submitted for these excluded medications post-July 1 and be ready to explain denials to patients. Note: Changes do not apply to members on annual drug lists (Basic Annual, Basic Multi-Tier Annual, Enhanced Annual, Enhanced Multi-Tier Annual, Performance Annual) until January 1, 2026.