Blue Cross and Blue Shield of Illinois

Blue Cross and Blue Shield of Illinois

 

 

May 3, 2013

Pharmacy Program Changes Effective July 1, 2013

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.

View the most up-to-date list of drug dispensing limits.

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.