Nov. 15, 2017
Pharmacy Program Quarterly Update – Changes Effective Jan. 1, 2018
Drug List Changes
Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) will be made to the Blue Cross and Blue Shield of Texas (BCBSTX) drug lists, effective Jan. 1, 2018.
Dispensing Limit Changes
BCBSTX’s prescription drug benefit program includes coverage limits on certain medications and drug categories. Dispensing limits are based on FDA-approved dosage regimens and product labeling.
Standard Utilization Management Program Package Changes
New Prior Authorization (PA) Program from FastPAth
A new PA program was added to the standard PA program effective Oct. 1, 2017, for all standard pharmacy benefit plans, upon renewal for non-ASO groups. The Tardive Dyskinesia PA program includes the target drug Ingrezza. The update also applies to ASO groups that have selected the auto update. For groups that have not selected auto updates, these programs are available for selection. Contact your BCBSTX representative for more information.
Combination GI Protectant Step Therapy (ST) Program Moving to PA
The Combination GI Protectant ST program is moving to the standard PA program effective Jan. 1, 2018. Members on the Basic, Enhanced or Performance drug lists with recent prescription history for the target drugs will be notified of the change. Note: Members who may have had a prior authorization approval currently in place from the ST program will not be impacted until their current PA approval expires in 2018.
Drug Category Separated from Therapeutic Alternatives PA Program
The target drug Doxepin 5% cream will be removed from the Therapeutic Alternatives standard PA program and included in a new standard PA program effective Jan. 1, 2018. The program Topical Doxepin will include this target drug and the targets Prudoxin and Zonalon. Members with a recent prescription history for Doxepin 5% cream and did not have the Therapeutic Alternatives PA program as part of their benefits prior to the effective date will be notified of the change. The new PA program will apply to all prescription drug lists.
PA and ST Program Changes Effective Jan. 1, 2018
Effective Jan. 1, 2018, several drug categories and/or targeted medications will be added to the PA and ST programs for standard pharmacy benefit plans, upon renewal for non-ASO groups. This includes ASO groups that have selected auto updates. For groups that have not selected auto updates, these programs will be available for selection beginning Jan. 1, 2018. Contact your BCBSTX representative for more information.
Please note: As a reminder, the PA and ST programs for standard pharmacy benefit plans correlate to the member’s drug list. Not all standard PA and ST programs may apply, based on the member’s current drug list. A list of PA and ST programs per drug list is posted on the member prescription drug plan information section of bcbstx.com.
Targeted mailings were sent to members affected by drug list revisions and/or exclusions, dispensing limit and prior authorization program changes per our usual process of notifying members prior to the effective date.
View the most up-to-date drug list and list of drug dispensing limits on bcbstx.com.
If you have any questions regarding these changes, contact your BCBSTX representative.
*These pharmacy changes apply to members and groups with prescription drug benefits administered through Blue Cross and Blue Shield of Texas (BCBSTX).
BCBSTX contracts with Prime Therapeutics® to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Plans, has an ownership interest in Prime Therapeutics.