This article is intended for members enrolled in an individual health insurance plan.
We offer several online resources where you can find basic answers to some of your questions.
When you sign in to MyPrime.com to search for a medication you take or have been prescribed, you will see whether or not it’s covered and get pricing estimates for both a 30-day and 90-day supply at a retail pharmacy or through the home delivery program.
You will also see if there are any coverage limitations or special requirements, such as a dispensing limit or prior authorization program or if the medication is a specialty drug that must be filled at a specialty pharmacy.
In addition to coverage details, MyPrime.com medication content also includes information about how a drug works, potential side effects and possible medication interactions, as well as available alternatives or generics.
You should talk to your doctor or pharmacist about any questions you have about your drugs.
Blue Access for MembersSM (BAMSM) Health Topics and Health Care School
If you have questions about health issues other than those addressed at MyPrime.com, log in to BAM to find quite a bit more.
In addition to information about your coverage, claims, how to find network doctors and pharmacies, and more, you can find basic information about health conditions in BAM.
Under the My Health tab, you will see a Health Topics link in the upper left of your screen. Under that, you will see a list of conditions. Each condition link leads to more information about what it is and how it may usually be diagnosed and treated. Treatment decisions are always between you and your doctor.
If you want more information, Health Care School offers multi-session online tutorials about several topics. Check the Health Care School box in the lower right of your BAM home screen to find information about:
- Understanding deductibles and out-of-pocket costs
- The ABCs of HSAs, HCAs and FSAs
- Understanding your explanation of benefits (EOB)
- Understanding the difference between in-network and out-of-network providers
- How to talk to your doctor
- Prescription drugs
What if you just want to know what a specific word or phrase means when you get a notice or account statement? Look no further than the glossary on our website. There you will find quick definitions for common insurance terms organized alphabetically.
To access the glossary from our home page at bcbstx.com, click on the Insurance Basics tab, and under Understanding Health Insurance on the left, click on Glossary.
Prime Therapeutics LLC is a separate pharmacy benefit management company contracted by Blue Cross and Blue Shield of Texas (BCBSTX) to provide pharmacy benefit management and related other services. In addition, contracting pharmacies are contracted through Prime Therapeutics. The relationship between BCBSTX and contracting pharmacies is that of independent contractors. BCBSTX along with several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.
MyPrime.com is an online resource offered by Prime Therapeutics LLC.