Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2017
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 additions were made to the Blue Cross and Blue Shield of Texas (BCBSTX) drug lists. Changes that will be effective as of July 1, 2017 are outlined below.
Drug List Updates (Coverage Additions) – As of July 1, 2017
| Preferred Brand1 | Drug Class/Condition Used For |
| Basic (formerly known as Standard) Drug List | |
| Eloctate | Hemophilia |
| Entresto | Heart Failure |
| Humulin R U-500 | Diabetes |
| Humulin R U-500 KWIKPEN | Diabetes |
| Kisqali | Cancer |
| Linzess | Irritable Bowel Syndrome |
| Vyvanse | ADHD |
| Xtandi | Cancer |
| Enhanced (formerly known as Generics Plus) Drug List | |
| Eloctate | Hemophilia |
| Entresto | Heart Failure |
| Humulin R U-500 | Diabetes |
| Humulin R U-500 KWIKPEN | Diabetes |
| Invokamet | Diabetes |
| Invokamet XR | Diabetes |
| Invokana | Diabetes |
| Kisqali | Cancer |
| Welchol | High Cholesterol |
| Xtandi | Cancer |
| Performance Drug List | |
| armodafinil tab 50 mg, 150 mg, 200 mg, 250 mg | Narcolepsy |
| clindamycin phosph-benzoyl peroxide (refrig) gel 1.2 (1)-5% | Acne |
| XIGDUO XR | Diabetes |
| XTAMPZA ER | Pain |
| ZERIT | Antiviral |
| Performance Select Drug List | |
| armodafinil tab 50 mg, 150 mg, 200 mg, 250 mg | Narcolepsy |
| BELSOMRA | Insomnia |
| BYSTOLIC | Hypertension |
| clindamycin phosph-benzoyl peroxide (refrig) gel 1.2 (1)-5% | Acne |
| olmesartan medoxomil tab 5 mg, 20 mg, 40 mg | Hypertension |
| olmesartan medoxomil-hydrochlorothiazide tab 20-12.5 mg, 40-12.5 mg, 40-25 mg | Hypertension |
| XIGDUO XR | Diabetes |
| XTAMPZA ER | Pain |
| ZERIT | Antiviral |
UTILIZATION MANAGEMENT PROGRAM CHANGES
- Effective July 1, 2017, the following changes will be applied:
- Injectable Atopic Dermatitis and Emflaza will be added to the standard Prior Authorization (PA) programs for standard pharmacy benefit plans, upon renewal for select members' plans. The Injectable Atopic Dermatitis PA program includes the target drug Dupixent. The Emflaza PA program includes the target drug Emflaza.
- Several targeted medications will be added to the current PA programs for standard pharmacy benefit plans, upon renewal for select members' plans. As a reminder, please review your patient’s drug list for the indicator listed in the Prior Authorization or Step Therapy column, as not all programs may apply. Also, please be sure to submit the specific prior authorization form for the medication being prescribed to your patient.
Targeted drugs added to current pharmacy PA standard programs, effective July 1, 2017
| Drug Category | Targeted Medication(s)1 |
| Basic (Standard) Drug List* | |
| Therapeutic Alternatives | Auvi-Q, generic metformin ER (Fortamet) |
Per our usual process of member notification prior to implementation, targeted mailings were sent to members affected by prior authorization program changes. For the most up-to-date drug list and list of drug dispensing limits, visit the Pharmacy Program section of our Provider website.
1Third party brand names are the property of their respective owners
Prime Therapeutics LLC is a pharmacy benefit management company. BCBSTX contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.
The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.
