2025 Prescription Drug Changes for Employer-Offered “Metallic” Plans

If you get your Blue Cross and Blue Shield of Illinois health care coverage through your job, changes to your 2025 pharmacy benefit program may start on January 1, 2025.¹

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, 2025, 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

If you have an HMO plan and would like to find out if your medication is impacted², you can review 2025 prescription drug list changes. If you have a non-HMO plan, you can check the 2025 drug list often for changes.

2025 Drug List

Here’s your 2025 drug list (for coverage that renews or starts on or after January 1, 2025):

HMO POS 6 Tier Drug List

Non-HMO POS 6 Tier Drug List

$0 HDHP-HSA Preventive Drug List (This applies only for Blue PPO Gold^SM 113, Blue PPO Gold^SM 115, Blue PPO Silver^SM 133, Blue PPO Silver^SM 200, Blue PPO Bronze^SM 106, Blue PPO Bronze^SM 132,  Blue PPO Bronze^SM 401, Blue Choice Preferred Gold PPO^SM 113, Blue Choice Preferred Gold PPO^SM 115, Blue Choice Preferred Silver PPO^SM 133, Blue Choice Preferred Silver PPO^SM 200, Blue Choice Preferred Bronze PPO^SM 106, Blue Choice Preferred Bronze PPO^SM 132, Blue Choice Preferred Bronze PPO^SM 401, Blue Options Gold^SM PPO 200, Blue Options Silver^SM PPO 107 and Blue Options Silver^SM PPO 404 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.

Commonly Used Drugs No Longer Covered

Here's a list of some drugs that are no longer covered as of January 1, 2025.³

If your prescription drug is on the list, you'll see other drug alternatives that may be options for you.

Find covered drug alternatives.

Ways to Save

• Be sure to use your BCBSIL member ID card when you fill prescriptions at an in-network pharmacy. Some medicines may be eligible for the MedsYourWay® drug discount card program. This program works with your pharmacy benefit to automatically find lower available costs. It compares drug discount card prices to your plan cost share amount. You'll pay the lower available price and what you pay counts toward your plan deductible or out-of-pocket maximum.
• 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.⁴  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 2025 network, visit myprime.com.

Please note, changes could be made to the pharmacies in the future. Not all retail network pharmacies may participate with MedsYourWay.

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.

¹ Members with a health plan provided through their employer will see these changes on their 2025 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 approval are not covered. 

³ Commonly used drugs that are no longer covered may not apply to all strengths/formulations. Third-party brand names are the property of their respective owners. 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.

⁴ The preferred pharmacy network pricing isn’t available for 100% cost-sharing plans or HMO plans.

MedsYourWay is not insurance. It is a drug discount card program that compares the drug discount card price for an eligible medication at participating pharmacies to the member’s benefit plan cost share amount and then applies the lower available price. Eligible medications are subject to change, prescription prices may vary by location and not all pharmacies participate. MedsYourWay is administrated by Prime Therapeutics, LLC, a separate company providing pharmacy solutions for your plan.