January 16, 2017
Please see the following announcements pertaining to the pharmacy program for Blue Cross and Blue Shield of North Carolina (BCBSNC).
New Drugs Recently Added to Utilization Management Program
The following drugs have recently been added to BCBSNC’s utilization management program. For additional information, please follow the instructions on this website to view the details your formulary.
Pharmacy Coverage Letters
BCBSNC sent letters to affected members to communicate important pharmacy coverage changes. Please view the sample member letter. Members were either notified of a formulary tier change to a drug they are taking or have taken in the last 4 months, or notified that a drug will no longer be covered.
Letter recipients should speak with their doctor about possible alternatives. For more information, they can contact the customer service number on the back of their ID card.
Reminder on HSA Preventive Rx & Medication Dedication Program
Effective January 1, 2017, BCBSNC has reduced the number of medications covered under the Medication Dedication Program and the HSA Enhanced Preventive Benefit Program.
The drugs removed from the programs consist of high cost brands and generics when there are suitable lower cost alternatives available in the program. The cost of these drugs will now be dependent on which tier they are on according to the health plan formulary.
Members who are currently taking an affected medication were notified late 2016 that are no longer part of the program and will no longer be available without charge.
Prior Authorization Changes
Evzio, a medication used to treat suspected opioid overdose, will now require Prior Authorization. This medication is received prior to an incident and kept on hand in the event of an emergency. Narcan, a similar medication, will continue to be available without Prior Authorization. Members who have used this medication in the last 12 months will receive a letter. Please view the sample member letter.
Below is a simplified message you can use to communicate this change with your employees.
BCBSNC Pharmacy Program Updates
Blue Cross and Blue Shield of North Carolina (BCBSNC) has recently made several changes to its pharmacy benefit program. As a result impacted members have been sent letters of notification. The following medications are affected.
- Adlyxin (Diabetes)
- Soliqua (Diabetes)
- Basaglar (Diabetes)
- Reyaldee (Secondary Hyperarathyroidism)
- Evzio (opioid overdose)
- Medications covered under the BCBSNC Medication Dedication & HSA Enhanced Preventive Program
If you are taking or have recently taken any of the drugs that changed you may have already received a letter from BCBSNC. You are encouraged to speak with your doctor about possible alternatives. For information on the specific drug changes, please follow the instructions on this website to view the details of your formulary, or contact the customer service number on the back of your ID card.