November 2016
Reminder: Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2016
Drug List (Formulary) Changes
Based on the availability of new prescription medications and the Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some revisions were made to the Blue Cross and Blue Shield of Texas (BCBSTX) Standard drug list and Generics Plus drug list that became effective on Oct. 1, 2016.
Brand Medications Added to the Standard and Generics Plus Drug Lists, Effective Oct. 1, 2016:
| Preferred Brand1 | Drug Class/Condition Used for |
| Afstyla | Hemophilia |
Brand Medications Added to the Standard Drug List, Effective Oct. 1, 2016:
| Preferred Brand1 | Drug Class/Condition Used for |
| Impavido | Leishmaniasis |
| Velphoro | Anemia |
Utilization Management Program Changes
Effective July 1, 2016, the Hetlioz Prior Authorization (PA) program changed its name to: Circadian Rhythm Disorders. All targeted medications and program criteria remained the same. Also, the Kalydeco (Cystic Fibrosis) specialty PA program officially changed its name to: Cystic Fibrosis.
Effective Oct. 1, 2016, several targeted medications were added to the current PA program for select members on standard pharmacy benefit plans.
Targeted drugs added to current pharmacy PA standard programs, effective Oct. 1, 2016:
| Drug Category | Targeted Medication(s)1,2 |
| Therapeutic Alternatives | Cardizem CD, Evzio*, Kazano, Lidocaine patch/ointment, Nesina, Oseni, Sitavig |
Targeted mailings were sent to select members affected by PA program changes. For the most up-to-date drug list and list of drug dispensing limits, visit the Pharmacy Program section of our website at bcbstx.com/provider.
1Third party brand names are the property of their respective owners.
2These lists are not all inclusive. Other medications may be available in this drug class.
*Due to Substance Abuse Parity, some members may not need to submit a PA request for Evzio to be considered for coverage.
Prime Therapeutics LLC is a pharmacy benefit management company. BCBSTX contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.
The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage, which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.