CommercialCoverageMedium impact
Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2025 – Part 2
BCBS Texas·TX · Pharmacy, Rheumatology, Dermatology +6 more·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jan 12, 2026
Summary
Blue Cross and Blue Shield of Texas is adding 40+ new medications to multiple pharmacy formularies effective January 1, 2025, including biosimilars (adalimumab, infliximab, tocilizumab variants), specialty drugs (FABHALTA for paroxysmal nocturnal hemoglobinuria, LITFULO for alopecia areata), and new formulations (ATORVALIQ, EZALLOR SPRINKLE). This is Part 2 of the quarterly update and does not require member notification. The billing team must verify these drugs are now covered and update any prior authorization rules that may apply.
Action Required
By December 31, 2024: Pharmacy and billing teams must update their formulary databases and billing software to reflect all new drug additions listed in this policy across all affected plan types (Balanced, Performance, Performance Annual, Performance Select, Basic, Enhanced, and their variants). Verify whether any of the newly added drugs require prior authorization, step therapy, or quantity limits by reviewing the complete pharmacy policy and utilization management guidelines. Update internal drug reference materials and train billing staff on the new coverage. When claims for these medications are submitted on or after January 1, 2025, ensure correct processing based on the patient's specific plan tier. Failure to update systems may result in incorrect claim denials or processing delays.