CurrentBlue Cross Blue Shield - New MexicoPolicy N/A

2026 Drug List

A portion of BCBSNM's 2026 Drug List (Part 1 of 21) showing covered outpatient pharmacy drugs, tier assignments, special requirement flags (PA, ST, QL, NM, AC, BH, SP), coverage considerations, exception processes, and therapeutic class listings (anti-infective excerpt and many other product entries).

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

Policy2026 Drug List

Policy CodePolicy N/A

Change TypeRoutine update (no material change)

Effective Date2026-04

Next Review Date

Key ActionProviders must verify special requirement flags (PA, ST, QL, NM, AC, BH, SP) adjacent to listed drugs and follow plan-specific prior authorization, step therapy, or quantity limit processes as indicated.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes in this update.

100+Products listed in this part

manyEntries with QL/PA/SP examples

severalSpecialty products (SP)

multiplePrior authorization (PA)

Part 1 of 21Document part

Coverage Summary & General Rules

General Coverage Considerations

General Coverage Considerations — covered when ALL of the following general rules are observed:

ALL of the following

All covered drugs shown on this Drug List are included based on FDA approval and committee review; drugs not shown are not covered under the pharmacy benefit.
Coverage is subject to the member's specific benefit plan terms and may vary by product, age, indication, or place of service (pharmacy vs medical).
Prior authorization (PA) may be required for some drugs to confirm indication, dosing, or appropriateness; PA requirements will generally be indicated by 'PA' in the Special Requirements column.
Quantity limits (QL) may apply to control dosing or supply (e.g., limits on days' supply or total units); QL flags will be noted on product entries.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

Policy2026 Drug List

Policy CodePolicy N/A

Change TypeRoutine update (no material change)

Effective Date2026-04

Next Review Date

SourceLink

On This Page

Exception Process

Exception Process — processes for PA exceptions and expedited reviews (operate when a prescriber requests coverage outside standard rules):

ALL of the following

Providers should submit prior authorization and exception requests through the payer's designated portal or by the phone/fax process shown on the member ID card.
Standard prior authorization decisions will be completed within the plan's normal review timeframe (refer to plan materials for exact business-day timelines).
Expedited (urgent) requests: when a prescriber states that the member faces a serious health risk or imminent deterioration without the drug, the plan will provide a decision within 24 hours of receipt of the expedited request.
Standard urgent or non-expedited requests will be adjudicated within 3 business days from receipt of all required information unless longer timelines are required by state law or plan terms.
If additional clinical information is needed to complete review, the plan will request it and the review timeline will pause until received; providers should promptly supply documentation to avoid delays.
Appeals and grievance instructions are available in the member's benefit materials and on bcbsnm.com; providers and members may follow those procedures for denied requests or unresolved exceptions.

Per-product Requirements/Limits

Per-product Requirements/Limits — examples of product-level flags that may appear on formulary entries and their operational meaning:

ALL of the following

NM — Non-Medical or Not Marketed: indicates products not shown on the list are not covered.
QL — Quantity Limit: product has a limit on units or days' supply; detailed QL values are provided on the product entry or supporting documents.
PA — Prior Authorization: prescriber must obtain authorization before coverage; PA criteria may require diagnosis, prior therapy, or additional documentation.
AC — Age or Clinical Criteria: coverage limited to specific age ranges or clinical indications consistent with FDA labeling or evidence-based guidelines; exact criteria are on the product entry.
SP — Specialty: product designated as specialty; may require specialty pharmacy dispensing, additional monitoring, or site-of-care controls.
Mapping: each formulary line will display the applicable combination of these flags (e.g., PA + QL + SP) to indicate which operational controls apply to that product.

Listed Drugs and Tiers (selected codes)

Listed Drugs and Tiers (anti-infective excerpt)mixed

AMOXICILLIN	amoxicillin (trihydrate) cap 250 mg, 500 mg; tab 500 mg, 875 mg; for susp 125 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml
amoxicillin (trihydrate) cap 250 mg, 500 mg	oral capsule
amoxicillin (trihydrate) for susp 125 mg/5ml, 200 mg/5ml, 250 mg/5ml	oral suspension
amoxicillin (trihydrate) for susp 400 mg/5ml	oral suspension (Amoxicillin)
amoxicillin (trihydrate) tab 500 mg, 875 mg	tablets
amoxicillin & k clavulanate for susp 200-28.5 mg/5ml	oral suspension
amoxicillin & k clavulanate for susp 250-62.5 mg/5ml, 400-57 mg/5ml	oral suspensions
amoxicillin & k clavulanate for susp 600-42.9 mg/5ml	Augmentin ES-600 suspension
amoxicillin & k clavulanate tab er 12hr 1000-62.5 mg	extended-release tablet
amoxicillin & k clavulanate tab 250-125 mg	tablet

1–10 of 87

1/9

Formulary products with Requirements/Limits and/or Quantity Limits (partial list from this part)mixedCovered

fluconazole for susp 10 mg/ml	fluconazole suspension 10 mg/ml
fluconazole for susp 40 mg/ml	Diflucan suspension 40 mg/ml
fluconazole tab 50 mg, 150 mg	tablets
fluconazole tab 100 mg, 200 mg	Diflucan tablets
flucytosine cap 250 mg, 500 mg	Ancobon
griseofulvin microsize susp 125 mg/5ml	suspension
griseofulvin microsize tab 500 mg	tablet
griseofulvin ultramicrosize tab 125 mg, 250 mg	tablets
itraconazole cap 100 mg	Sporanox capsule
itraconazole oral soln 10 mg/ml	Sporanox oral solution

1–10 of 18

1/2

Products with Prior Authorization (PA)mixedCovered

ABACAVIR SULFATE SOLN 20 MG/ML	Ziagen oral solution 20 mg/ml
abacavir sulfate tab 300 mg	tablet
abacavir sulfate-lamivudine tab 600-300 mg	combination
APRETUDE	cabotegravir im extended release susp 600 mg/3 ml
APTIVUS	tipranavir cap 250 mg
ATAZANAVIR SULFATE	Reyataz caps 150/200/300 mg
BARACLUDE	entecavir formulations
BIKTARVY	bictegravir-emtricitabine-tenofovir alafenamide
CIMDUO	lamivudine-tenofovir disoproxil fumarate 300-300 mg
darunavir tab 600 mg, 800 mg	Prezista

1–10 of 55

1/6

Products marked Specialty Pharmacy (SP)mixedCovered

ARIKAYCE	SP - amikacin liposomal
APRETUDE	SP - cabotegravir extended release
BIKTARVY	SP - bictegravir-emtricitabine-tenofovir alafenamide
EPCLUSA	SP - sofosbuvir-velpatasvir
HARVONI	SP - ledipasvir-sofosbuvir
MAVYRET	SP - glecaprevir-pibrentasvir
PREVYMIS	SP - letermovir
SIRTURO	SP - bedaquiline
SOVALDI	SP - sofosbuvir
VOSEVI	SP - sofosbuvir-velpatasvir-voxilaprevir

1–10 of 12

1/2

PALFORZIA levels / specialty productsmixedCovered

PALFORZIA LEVEL 1	Peanut allergen powder - initial dosing level
PALFORZIA LEVEL 2	Maintenance escalation level
PALFORZIA LEVEL 3	Maintenance escalation level
PALFORZIA LEVEL 4	Maintenance escalation level
PALFORZIA LEVEL 5	Maintenance escalation level
PALFORZIA LEVEL 6	Maintenance escalation level
PALFORZIA LEVEL 7	Maintenance escalation level
PALFORZIA LEVEL 8	Maintenance escalation level
PALFORZIA LEVEL 9	Maintenance escalation level
PALFORZIA LEVEL 10	Maintenance dosing

1–10 of 13

1/2

Selected High-Cost / Specialty / Antivirals / Hep C (examples)mixedCovered

EPCLUSA	sofosbuvir-velpatasvir (pellet & tablet)
HARVONI	ledipasvir-sofosbuvir (tablet & pellet)
MAVYRET	glecaprevir-pibrentasvir (tablet & pellet)
VOSEVI	sofosbuvir-velpatasvir-voxilaprevir
LIVTENCITY	maribavir
PEGASYS	peginterferon alfa-2a formulations
SOVALDI	sofosbuvir

Antineoplastics and selected oncology (partial list)mixedCovered

ABIRATERONE ACETATE 250 MG	Zytiga 250 mg
ABIRATERONE ACETATE 500 MG	Zytiga 500 mg
ALECENSA	alectinib
ALUNBRIG	brigatinib (initiation pack / 30/90/180 mg)
BRAFTOVI	encorafenib
BRUKINSA	zanubrutinib 80/160 mg
CABOMETYX	cabozantinib 20/40/60 mg
CALQUENCE	acalabrutinib 100 mg
CAPECITABINE 150/500 MG	Xeloda
CYCLOPHOSPHAMIDE TAB 50 MG	cyclophosphamide

1–10 of 14

1/2

Antiinfective Agents - Misc / Other groups (selected) mixed

XIFAXAN	rifaximin tab 200 mg, 550 mg
RIFAMPIN	rifampin caps 150 mg, 300 mg
RIFABUTIN	rifabutin cap 150 mg (Mycobutin)
PYRAZINAMIDE	pyrazinamide tab 500 mg
FLUCONAZOLE	fluconazole tabs & suspensions
POSACONAZOLE	posaconazole susp & tabs (Noxafil)
VORICONAZOLE	voriconazole susp & tabs (Vfend)
DIFICID	fidaxomicin 200 mg tab
GENTAMICIN/AMINOGLYCOSIDES	selected inhaled/neb/injectable formulations

Antimalarials / Anthelmintics / Anti-infective - examplesmixed

pyrimethamine tab 25 mg	Daraprim
ANTIMALARIALS	group products (examples)
ANTHELMINTICS	albendazole, benznidazole, ivermectin, praziquantel examples

Vaccines / Toxoids / Biologicals (selected)mixedCovered

VACCINES	selected vaccine entries
TOXOIDS	toxoid and combination toxoid vaccines
BIOLOGICALS MISC	biologicals and SLIT/allergen products

Comprehensive antiviral / HIV / HBV / HCV combinations (consolidated)mixedCovered

BIKTARVY	bictegravir-emtricitabine-tenofovir alafenamide tabs (various strengths)
GENVOYA	elvitegravir-cobicistat-emtricitabine-tenofovir alafenamide
STRIBILD	elvitegravir-cobicistat-emtricitabine-tenofovir df
TRIUMEQ	abacavir-dolutegravir-lamivudine
DESCOVY	emtricitabine-tenofovir alafenamide
DESCOVY 200-25 MG	emtricitabine-tenofovir alafenamide 200-25 mg
CIMDUO	lamivudine-tenofovir disoproxil fumarate 300-300 mg
EMTRIVA SOLN 10 MG/ML	emtricitabine oral solution
VIREAD	tenofovir disoproxil fumarate tabs & oral powder
VEMLIDY	tenofovir alafenamide 25 mg

Preserved legacy and supportive products (selected)mixed

oseltamivir phosphate	Tamiflu caps & suspensions
PAXLOVID	nirmatrelvir & ritonavir packs
RELENZA DISKHALER	zanamivir aerosol powder
RIBAVIRIN	ribavirin cap/tab 200 mg
PEGASYS	peginterferon alfa-2a
PREVYMIS	letermovir
MAVYRET	glecaprevir-pibrentasvir

Antibiotics - selected inhaled/neb/ophth/otc/high-risk itemsmixedCovered

TOBI PODHALER	tobramycin inhalation powder
tobramycin nebu soln 300 mg/5ml	Tobi neb soln
tobramycin nebu soln 300 mg/4ml	Bethkis neb soln
TOBI	tobramycin neb/inhaled products
TOBRAMYCIN OPHTH	ophthalmic formulations

Antibacterials - TB and atypical mycobacteria (selected)mixedCovered

isoniazid tab 100 mg, 300 mg	isoniazid tablets
isoniazid syrup 50 mg/5ml	oral suspension
rifampin cap 150 mg, 300 mg	rifampin
rifabutin cap 150 mg	Mycobutin
pyrazinamide tab 500 mg	pyrazinamide
PRETOMANID	pretomanid (part of TB regimens)

Comprehensive list - HIV / Antivirals (expanded examples)mixedCovered

APRETUDE - 600 MG/3 ML	cabotegravir IM extended-release injection
APRETUDE	cabotegravir product line
ISENTRESS HD	raltegravir 600 mg
NORVIR 100 MG	ritonavir packets & tabs
ODEFSEY	emtricitabine-rilpivirine-tenofovir alafenamide
OXFORD/legacy	selected older regimens and formulations

Expanded systemic antiinfectives and misc inpatient/clinic-administered drugsmixed

AMBULATORY INJECTABLES	selected clinic-administered antiinfectives
ANTINEOPLASTIC AGENTS	refer to oncology section for full list
BIOLOGICALS MISC	see biologicals block

Preservation of original listed codes (misc long tail) mixed

ALL LISTED GENERICS AND BRANDS

Full document contains many additional codes preserved in main list (see full drug list)

OpenPayer

2026 Drug List

Coverage Summary & General Rules

Formulary Entries, Tiers & Requirements/Limits

Listed Drugs and Tiers (selected codes)

Provider Actions & Operational Steps

Quantity Limits & Notable Thresholds

Revision History