BCBSNC Utilization Management Program Drug Changes

June 16, 2017

Blue Cross and Blue Shield of North Carolina (BCBSNC) has made some changes to its drug Utilization Management Program. They do this for several reasons, including:

  • Helping control the prices of prescription drugs for customers
  • Utilization management and formulary management help BCBSNC provide members with access to drugs that are safe, effective and as cost-efficient as possible.
  • Helping members get the most appropriate medications via regular review

For some drugs, the change will be effective July 1, 2017. BCBSNC will be mailing letters to affected members in this category who have received any affected medications in the past four months.

NOTE: This will not apply to any self-funded employer group that carves our pharmacy benefits to another pharmacy benefits manager. These changes also will not apply to the State Health Plan, Federal Employee program or Medicare Part D members.

For the most up to date information please visit www.bcbsnc.com/umdrug. Members can:

  • Find out specific information with regards to their own benefit plan and formulary
  • Perform a specific drug search
  • Find details on drugs that have specific limitations
  • Find an explanation of terms used in a drug search
  • Review how to request coverage for a drug not included in the formulary

EMPLOYEE COMMUNICATION
Below is a simplified message you can use to communicate this change with your employees.

BCBSNC Utilization Management Program Drug Changes

Blue Cross and Blue Shield of North Carolina (BCBSNC) has made some changes to its drug Utilization Management Program. They do this for several reasons, including:

  • Helping control the prices of prescription drugs
  • Utilization management and formulary management help BCBSNC provide you with access to drugs that are safe, effective and as cost-efficient as possible.
  • Helping you get the most appropriate medications via regular review

For some drugs, the change will be effective July 1, 2017. One example of affected medication is topical steroids. If you have received any affected medications in the past four months, BCBSNC will be mailing you a letter.

For the most up to date information please visit www.bcbsnc.com/umdrug where you can:

  • Find out specific information with regards to your own benefit plan and formulary
  • Perform a specific drug search
  • Find details on drugs that have specific limitations
  • Find an explanation of terms used in a drug search
  • Review how to request coverage for a drug not included in the formulary

You can also find more information about prescription drug coverage and costs on the BCBSNC website.