Pharmacy Benefits

Mail Order Prescription Drugs

FirstCare provides our members the ability to obtain prescriptions through mail order. Mail order copayments allow for up to a 90 day supply. View and print our mail order forms:

• Maxor (pdf, 1.74 MB) - Amarillo and Lubbock Service Area
• Express Scripts (pdf, 509 kb) - Abilene and Waco Service Area

Prescription Drug Benefit

View our drug coverage list (pdf, 490 kb).

View your prescription drug copayments (pdf, 235 kb).

The FirstCare benefit plan for eligible State of Texas and higher education employees, retirees and dependents includes a prescription drug benefit.  This benefit provides broad prescription drug coverage, and allows you to share in the savings when you and your doctor decide on certain medications.

Your specific prescription benefit plan design may not cover certain categories of drugs, regardless of their appearance in the following list. Please refer to FirstCare's Evidence of Coverage (pdf, 238 kb) for coverage exclusions.

All drugs covered under this benefit plan are assigned to one of the following three copayment tiers:

• Tier 1: Lowest copayment
• Tier 2: Higher copayment for a selected list of Brand Name Drugs
• Tier 3: Higher copayment than Tier 2 for other Brand Name Drugs

A panel of physicians and pharmacists, who evaluate the various drugs available to treat specific conditions, assigns covered drugs on one of the three copayment tiers.  Certain medications require Prior Authorization in order to be a covered benefit.  In addition, some classes of drugs are subject to quantity dispensing limitations.  Periodically, the Drug Coverage List (DCL) (pdf, 490 kb)may be reviewed as new drugs and drug therapies are introduced.

 

More Highlights

• For specific information regarding your prescription coverage, please consult a FirstCare Customer Service Representative at (800) 884-4901 or refer to your Evidence of Coverage.
• If you or your doctor requests a Brand Name drug when a generic equivalent is available you will pay the generic copayment plus the cost difference between the price of the Brand Name and generic drug.
• The pharmacy may contact your doctor after receiving your prescription to request consideration of another product or generic equivalent, which may result in your doctor prescribing a different Brand Name or generic equivalent in place of your original prescription.

The Drug Coverage List is subject to change.  However, a drug will not be removed from this List without you having first received notice in advance of such removal.

The following situations do not constitute a change in benefit coverage, rather they are normal occurrences in the pharmaceutical market:

• Changes in prior authorization clinical criteria approved by The Pharmacy & Therapeutics Committee
• Generic drugs whose classification status changes to Brand Name during the contract period.
• Brand Name drugs that have new generic-equivalent products available during the contract period automatically move to Tier 3 status with a corresponding higher out-of-pocket cost. The generic equivalent drug is automatically covered at the Tier 1 copayment.
• Other newly approved FDA drugs are automatically placed on the Tier 3 drug copayment level if used to treat a covered medical condition.

Diabetic drugs and insulin are covered under the Basic Medical Benefit at the copayment Tier assigned on this Drug List.  Drug names are listed at the lowest Tier available.  Not all strengths and dosage forms are available in a generic version and are covered at a higher Tier.  Only generics are covered at Tier 1 copayment.  Check with your pharmacy to verify generic availability.