Pharmacy Program Update: Formulary Changes Effective July 1

Standard 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 effective July 1, 2015.

Brand Medications Added to the Drug List, Effective July 1, 2015

Utilization Management Program Changes
Effective July 1, 2015, the Idiopathic Thrombocytopenic Purpura (ITP) specialty prior authorization (PA) program changed its name to: Thrombopoietin Receptor Agonists. The Familial Hypercholesterolemia specialty PA program also changed its name to: Hypercholesterolemia. All targeted medications and program criteria for both programs remains the same.

For the most up-to-date drug list and list of drug dispensing limits, visit the Pharmacy Program section of the BCBSTX provider website.

¹Third party brand names are the property of their respective owners.

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 other 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.