Blue Cross and Blue Shield of Illinois

 

 

June 14, 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 are being made to the standard Blue
Cross and Blue Shield of Illinois (BCBSIL) formulary effective July 1, 2013.

Standard Formulary Additions

Brand Medications Being Added to the Formulary Effective July 1, 2013
Formulary Brand*

Drug Class/
Condition Used For

Advate

Hemophilia

Alphanate

Hemophilia

AlphaNine SD

Hemophilia

Bebulin

Hemophilia

Bebulin VH

Hemophilia

BeneFIX

Hemophilia

Corifact

Hemophilia

FEIBA NF

Hemophilia

FEIBA VH

Hemophilia

Helixate FS

Hemophilia

Hemophil M

Hemophilia

Humate-P

Hemophilia

Koate-DVI

Hemophilia

Kogenate FS

Hemophilia

Kogenate FS with BIO-SET

Hemophilia

Letairis

Pulmonary Arterial Hypertension

Monoclate-P

Hemophilia

Mononine

Hemophilia

NovoSeven RT

Hemophilia

Potassium Citrate

Kidney Function

Profilnine SD

Hemophilia

Recombinate

Hemophilia

Wilate

Hemophilia

Xarelto

Anticoagulant

Xyntha

Hemophilia

Xyntha Solofuse

Hemophilia

*Third-party brand names are the property of their respective owner.

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)*

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.

For the most up-to-date list of drug dispensing limits, visit bcbsil.com.
 
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. 

 
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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.