Pharmacy Program Updates Effective Oct. 1, 2015 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 Oct. 1, 2015. Brand Medications Added to the Drug List, Effective Oct. 1, 2015 Preferred Brand1 | Drug Class/Condition Used for | Arnuity Ellipta | Asthma | Pazeo | Opthalmic Antihistamine | NovoEight | Hemophilia |
Effective Oct. 1, 2015, dispensing limits were added for the following drugs: Drug Class and Medication1 | Product Strength(s) | Dispensing Limit | Diabetes (GLP-1 Receptor Agonists) | Bydureon (exenatide) | 2 mg syringe | 4 syringes per 28 days | Fibromyalgia | Lyrica (pregabalin) | 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg capsule | 90 capsules per 30 days | Lyrica (pregablin) | 225 mg, 300 mg capsule | 60 capsules per 30 days | Hypercholesterolemia (HoFH) | Juxtapid | 5 mg, 10 mg | 30 capsules per 30 days | Oral PAH | Tyvaso starter kit | 0.6 mg/mL | 1 kit per 180 days | Tyvaso institutional starter kit | 0.6 mg/mL | 1 kit per 180 days | Tyvaso | 0.6 mg/mL, 4 pack carton | 7 packages per 28 days | Tyvaso | 0.6 mg/mL refill kit | 1 package per 28 days | Ventavis | 10 mcg/mL, 20 mcg/mL | 270 ampules per 30 days | Thrombopoietin Receptor Agonists | Promacta | 25 mg | 30 tablets per 30 days | Promacta | 75 mg | 60 tablets per 30 days |
Utilization Management Program Changes
Effective Oct. 1, 2015, the Proton Pump Inhibitors (PPI) step therapy program was removed from all BCBSTX prescription drug benefit plans. Members are encouraged to use available less costly options, such as a covered prescription-strength generic or over-the-counter product. Targeted Drugs Added to Current Pharmacy PA Standard Programs, Effective Oct. 1, 2015 Drug Category | Targeted Medication(s)1 | Doxycycline/Minocycline | Doxycycline 75 mg, Doxycycline 150 mg capsules, Doxycycline Monohydrate | Erythropoiesis Stimulating Agents (ESAs) | Mircera | Pulmonary Arterial Hypertension (PAH) | Tyvaso, Ventavis |
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. |
