Blue Cross NC Diabetic Supplies and Pharmacy Updates

March 14, 2019

Diabetic Supplies Update
Recently Blue Cross and Blue Shield of North Carolina (Blue Cross NC) opened their durable medical equipment (DME) network for the distribution of insulin pumps and continuous glucose monitors (CGMs). Their goal was to provide members with more choices. Insulin pumps, CGMs and their related supplies are now eligible for in-network benefits when they are obtained from any network-participating supplier.

Here are a few important points:
• Edgepark is no longer the Blue Cross NC exclusive provider for these supplies
• Members can get in-network benefits when these items are obtained from any in-network DME supplier
• The Blue Cross NC Provider Education team has contacted all DME suppliers so they can also inform their Blue Cross NC customers of their options

Participating Network DME suppliers can be found using the Find a Doctor, Drug, or Facility tool available at BlueCrossNC.com.

Recent Pharmacy Updates
Blue Cross NC periodically makes changes to their pharmacy benefits. They have made a few changes to their Utilization Management Program over the past few months.

Medications that require prior authorization, step therapy or quantity limits fall under Utilization Management.
Future changes are also expected, as Blue Cross NC constantly reviews medical research and costs of medications, in order to cover the most effective medicines while attempting to keep costs affordable.

When these changes occur, Blue Cross NC notifies both participating providers as well as affected members who have taken any affected medications in the past four months.

Full details of changes to the Utilization Management Program can be found online.

Members can also find more information about prescription drug coverage and costs on the Find a Drug or Pharmacy page.

 

EMPLOYEE COMMUNICATION

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

 

Do you purchase diabetic supplies under your Blue Cross NC health plan?

Blue Cross NC has made it easier to purchase durable medical equipment (DME), which includes insulin pumps and continuous glucose monitors (CGMs). Their goal was to provide members with more choices.

Insulin pumps, CGMs and their related supplies are now eligible for in-network benefits when they are obtained from any network-participating supplier. You are no longer required to use Edgepark as an exclusive provider for these supplies.

Participating Network DME suppliers can be found using the Find a Doctor, Drug, or Facility tool available at BlueCrossNC.com.

Blue Cross NC Pharmacy Updates
Blue Cross NC periodically makes changes to their pharmacy benefits, and this can occur during the course of our plan year. They have made a few changes to their Utilization Management Program over the past few months. Medications that require prior authorization, step therapy or quantity limits fall under Utilization Management.

Future changes are also expected, as Blue Cross NC constantly reviews medical research and costs of medications. When these changes occur, Blue Cross NC notifies both participating providers as well as affected members who have taken any affected medications.

To see full details of changes to the Utilization Management Program and if you have been affected, please visit bcbsnc.com/umdrug and review the changes that may have occurred to any medication that you are prescribed.

More information about prescription drug coverage can be found on the Find a Drug or Pharmacy page.