To encourage continued use of
generics and preferred brand-name medications, Blue Cross and
Blue Shield of NC is expanding its list of restricted
(non-preferred) access drugs to include certain triptans, SSRI
antidepressants and hypnotics. As a result, these
medications will be subject to BCBSNC’s prior
review/certification requirements effective April 1,
2010. A brief summary of the affected pharmaceuticals
and the details of these changes are provided
below:
Triptans (migraine
therapy)
Requires users of nonpreferred triptans
(Amerge, Axert, Frova, Sumavel DosePro, Treximet, Zomig and
Zomig ZMT) to try sumatriptan (generic Imitrex), Relpax,
Maxalt or Mazalt MLT before the nonpreferred drug will be
covered. These drugs are commonly used to treat migraine
headaches.
SSRI
Antidepressants
Requires new users of nonpreferred
selective serotonin reuptake inhibitors (SSRIs) (Lexapro,
Luvox CR and Pexeva) to try citalopram (generic Celexa),
fluoxetine (generic Prozac or Sarafem), fluvoxamine (generic
Luvox), paroxetine (generic Paxil), or sertraline (generic
Zoloft) before the nonpreferred drug will be covered.
These drugs are commonly used to treat depression,
obsessive-compulsive disorder or anxiety disorders.
Hypnotics (prescription
sleep aids)
Requires users of nonpreferred
hypnotics (Ambien CR, Edluar, Lunesta, Rozerem and Zolpimist)
to try zaleplon (generic Sonata) or zolpidem (generic Ambien)
before the nonpreferred drug will be covered. These
drugs are commonly used to treat insomnia.
Early next month, BCBSNC will mail
letters to approximately 16,000 impacted members explaining
the new certification requirements. The letters will be
sent to members who are currently prescribed one of the
non-preferred drugs.
Employers should note that
if an affected member employee attempts to fill a prescription
for one of these drugs without first obtaining prior
review/certification on or after April 1, the claim will be
rejected at the pharmacy. As a result of the
claim rejection, the member employee may be directed to
contact their prescribing provider to discuss other treatment
options that would be appropriate for his or her
condition.
Should you have any further
questions regarding this new prior review/certification
requirement, please contact our office at (919)
403-1986.
