Jan. 14, 2016

2015 to 2016 Medicare Part D Formulary Changes
Blue Cross MedicareRx (PDP)^SM/Blue Cross Medicare Advantage (HMO)^SM/Blue Cross Medicare Advantage (HMO-POS)^SM /Blue Cross Medicare Advantage (PPO)^SM

Based on Centers for Medicare & Medicaid Services (CMS) mandates (i.e., safety concerns, drugs that no longer meet the CMS definition of a “Part D medication,” etc.) and a regular review of changes in the pharmaceutical marketplace, the Blue Cross MedicareRx/Blue Cross Medicare Advantage 2016 Part D plans will have formulary and utilization management changes for 2016.

Members were alerted of these changes in late November 2015 via targeted mailings as well as in the Annual Notice of Change (ANOC) sent to all current members with Blue Cross MedicareRx/Blue Cross Medicare Advantage Medicare Part D plans. 

Visit the Pharmacy Program/Medicare Part D Updates section of our website at bcbsok.com/provider  for a quick reference that includes the “Top 30” medications impacted by these formulary changes. For the full 2016 formulary, please refer to the website (bcbsok.com/medicare).

Members are instructed to ask their doctor about the medications they are prescribed, and if any of these formulary, quantity limit or prior authorization changes may impact them, to have a prescription written for a formulary alternative. If the alternative is not appropriate for your patient, please start a coverage determination for the medication needed. Forms are available on the website (bcbsok.com/medicare) under “Drug Information > Utilization Management”.
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Blue Cross Medicare Advantage plans are provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC) (PPO plans), and GHS Health Maintenance Organization, Inc. d/b/a BlueLincs HMO (BlueLincs) (HMO and HMO-POS plans), and GHS Managed Health Care Plans (GHS-MHC) (HMO and HMO-POS plans), Independent Licensees of the Blue Cross and Blue Shield Association. HCSC, GHS-MHC, and BlueLincs are Medicare Advantage organizations with a Medicare contract. Enrollment in HCSC’s, GHS-MHC’s, and BlueLincs’ plans depends on contract renewal.

Blue Cross MedicareRx is a prescription drug plan provided by HCSC Insurance Services Company HISC), an Independent Licensee of the Blue Cross and Blue Shield Association. A Medicare-approved Part D sponsor. Enrollment in HISC’s plan depends on contract renewal.

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.