| Oct. 8, 2015 Pharmacy Program Updates: Pharmacy Changes Effective October 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 Oklahoma (BCBSOK) 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 |
Dispensing Limit Changes
The BCBSOK standard prescription drug benefit program includes coverage limits on certain medications and drug categories. Dispensing limits are based on U.S. Food and Drug Administration (FDA) approved dosage regimens and product labeling. 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 | Lyrica (pregablin) | 20 mg/mL oral solution | 900 mL solution 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 BCBSOK 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. Additionally, specific targeted drugs were added to current Prior Authorization (PA) programs for standard pharmacy benefit plans. 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 | Drug Categories Added to the Pharmacy PA Program Drug Category | Targeted Medication(s)1 | Afrezza | Afrezza | Hetlioz | Hetlioz | Korlym | Korlym | Myalept | Myalept |
Drug Categories Added to the Pharmacy ST Program
Drug Category | Targeted Medication(s)1 | Atopic Dermatitis | Elidel, Protopic | Fibrate | Antara, Fenoglide, Fibricor, Lipofen, Lofibra, Tricor, Triglide, Trilipix | Ophthalmic Prostaglandins/Glaucoma | Lumigen, Rescula, Travatan Z, Travaprost, Xalatan, Zioptan |
Targeted Drugs Added to Current Pharmacy PA Standard Programs
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 |
Targeted mailings were sent to members affected by prior authorization program changes per our usual process of member notification prior to implementation. For the most up-to-date drug list and list of drug dispensing limits, visit the Pharmacy Program section of our website at bcbsok.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. Prime Therapeutics LLC is a pharmacy benefit management company. BCBSOK contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSOK, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. |
