Standard Formulary Changes Based on Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some revisions will be made to the standard Blue Cross and Blue Shield of Illinois (BCBSIL) formulary effective July 1, 2013.
Standard Formulary Deletions
Brand Medications Moving to a Higher Out-of-Pocket Payment Level (July 1, 2013)
Non-Formulary Brand*
Condition Used For
Generic Formulary Alternative(s)
Formulary Brand Alternative(s)1
Prevpac
Ulcer
N/A
N/A
Pylera
Ulcer
N/A
N/A
*Third-party brand names are the property of their respective owner N/A = Not available
Standard Formulary Dispensing Limit Changes BCBSIL’s standard prescription drug benefit program includes coverage limits on certain medications and drug categories. Dispensing limits are based on FDA-approved dosage regimens and product labeling.
Effective July 1, 2013, dispensing limits will be added for the following drugs:
Drug Class and Medications*
Dispensing Limit
Blood Modifying Drugs
Eliquis (apixaban)
60 tabs/30 days
Opioid Dependence
Suboxone (buprenorphine/naloxone)
60 films or tabs/30 days
Subutex (buprenorphine)
60 tabs/30 days
*Third-party brand names are the property of their respective owners.
Targeted mailings were sent to members affected by changes in dispensing limits per our usual process of notifying members at least 60 days prior to implementation.
Standard Utilization Management Program Package Changes
Prior Authorization (PA) Addition Effective July 1, 2013, the drug category listed in the table below will be added to the PA program for all standard benefit plans upon renewal.
Drug Category
Targeted Medications*
Opioid Dependence
Suboxone, Subutex
*Third-party brand names are the property of their respective owners.
Targeted mailings were sent to members affected by this change per our usual process of notifying members at least 60 days prior to implementation.
If you have questions regarding these changes, please contact your BCBSIL representative.
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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.