Blue Cross and Blue Shield of Illinois

 

January 17, 2014

Group Markets
Pharmacy Program Changes Effective April 1, 2014

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 April 1, 2014.

Standard Formulary Deletions

Brand Medication Moving to a Higher Out-of-Pocket Payment Level
Effective April 1, 2014
Non-Formulary Brand*

Condition
Used for

Generic Formulary Alternative(s)1

Formulary Brand Alternative(s)*,1

Solaraze

Actinic Keratosis

fluorouracil cream, imiquimod cream

Carac, Zyclara

*Third-party brand names are the property of their respective owner.
1
This list is not all inclusive. Other medications may be included in this drug class.

Targeted mailings were sent to members affected by this change per our usual process of notifying members at least 60 days prior to implementation.

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 April 1, 2014, dispensing limits will be added for the following drugs:         
Drug Class and Medication*

Dispensing Limit

Antibiotics

     Alinia tabs (nitazoxanide)

6 tabs/30 days

     Zithromax tabs (azithromycin)

60 tabs/180 days

Diabetes

      Invokana tabs (canagliflozin)

30 tabs/30 days

Multiple Sclerosis

      Tecfidera Starter Kit (dimethyl fumarate)

60 caps/180 days

      Tecfidera 120 mg caps (dimethyl fumarate)

14 caps/180 days

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

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.

If you have questions regarding these changes, please contact your account 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.