Download What`s Changing on the Prescription Drug List?

What’s Changing on the Prescription Drug List?
Essential Formularies: Individual, Small Group and with Preventive Copays
Every year BlueCross BlueShield of Tennessee reviews the Prescription Drug List (PDL) to
determine changes based on a drug’s effectiveness, safety and affordability. While many changes
to the Prescription Drug List occur at the beginning of the year changes can occur at any time
because of market changes including:
• Release of new drugs to the market after FDA approval
• FDA removal of drugs from the market
• Release of new generic drugs to the market
The following changes to the PDL for 2017 apply to the formularies listed below:
• Essential Formulary for Individual and Small Group Plans (5 tier plan)
• Essential Formulary with Preventive Drug Copays (6 tier plan)
Moving to the Preferred Brand (Tier 2) Effective 1/1/17:
• Alphagan P 0.1% drops
• Bunavail QL
• Butrans
PA, QL
Transdermal
• Combigan
• Estrace 0.01% cream
• Finacea
• Renvela
• Striverdi Respimat
• Trulicity
• Viibryd
Moving to the Non-Preferred Brand (Tier 3) Effective 1/1/17:
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Alrex ST
Azopt ST
Bepreve ST
Betimol ST
Crestor
Emverm
Enstilar
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Evamist
Nucynta QL
Nucynta ER PA, QL
Osphena ST
Pradaxa
Premarin cream ST
• Trintellix
• Utibron Neohaler
Moving to Non-formulary Status (Excluded From Formulary) Effective 1/1/17:
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Aczone 5% gel
Alodox 20 mg kit
Atralin
B-12 Compliance
B-12 Kit
Beconase AQ
Benzaclin gel w/pump
Brand prenatal vitamins
buprenorphine tablets
Carac
Differin 0.1% cream
Differin 0.3% gel
Duac
Dymista
Flector patch
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Glumetza
Hpr/Hpr Plus foam, cream
Hpr Plus Hydrogel
Hpr Plus MB Hydrogel
Hylatopic/Hylatopic Plus foam, cream
Letairis
Limbrel
Lorzone
Mb Hydrogel
metformin ER (generic for Glumetza)
Multigen
Nalfon
Nasonex
Nivatopic Plus cream
Oleptro ER
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Omnaris
Opana ER
Pancreaze
Physicians EZ Use B-12
Pramosone E
Protopic
Select multi-source brand name drugs
Sorilux
Testim
Vasculera
Veramyst
Victoza
Zyclara
Zylet
Changes to the BlueCross Specialty Drug List Effective 1/1/17:
Additions:
• Cosentyx PA, SPRx
• Kitabis Pak QL, SPRx
• leuprolide SQ PA, SPRx
Deletions:
• Glatopa
• Pertzye
• TobiPodhaler
Changes to Prior Authorization Requirements Effective 1/1/17:
• Prior authorization required for all long-acting opioids
Changes to Quantity Limitation Requirements Effective 1/1/17:
• Diabetic test strips ................................................................................................................................................................................................................ 102 strips/30 days
• Short-acting beta agonist inhalers (ProAir HFA/ Respiclick, Proventil HFA, Ventolin HFA, Xopenex HFA)................................ 2 inhalers/30 days
Changes to Step Therapy Requirements Effective 1/1/17:
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Acuvail, Ilevro, Nevanac ............................................................................................................................................................Requires trial and failure of Prolensa
Alocril, Alomide, Alrex, Bepreve, Elestat, Emadine, Lastacaft ................................................................ Requires trial and failure of Pataday or Pazeo
Azopt, Betimol, Betopic S, Cosopt PF, Istalol, Simbrinza......................................................... Requires trial and failure of Alphagan P or Combigan
Non-preferred diabetic test strips ......................Requires trial and failure of Bayer® (Contour/Breeze2) or Lifescan® (One Touch) test strips
Osphena, Premarin cream, Vagifem ..............................................................................................................Requires trial and failure of Estrace 0.01% cream
Changes to the 2017 Affordable Care Act (ACA) $0 Copay Contraceptive List Effective 1/1/17:
Additions:
• Larissia
Deletions:
• Ortho Tri Cyclen Lo
• Ovcon-35
Changes to the 2017 Affordable Care Act (ACA) $0 Copay Preventive List Effective 1/1/17:
Deletions:
• Iron supplements
Changes to the 2017 Blue Cross High Deductible Health Plan (HDHP) Preventive List Effective
1/1/17:
Additions:
• Aptiom
• Fycompa tablets
• Humulin R U-500
• Kaitlib FE
• Larissia
• molindone
• Novolog Flexpen
• olmesartan medoxomil
• olmesartan medoxomil -hctz
• Pulmicort Flexhaler
• rosuvastatin
• roweepra
• Spritam
• Stiolto Respimat
• Striverdi Respimat
• trimiprimine
• Trinessa Lo
• Vienva
• Viibryd
Deletions:
• Foradil
• Glatopa
• Victoza
Tier Changes:
• Pradaxa
(Moving to Non-Preferred Brand)
Legend:
PA – This drug requires prior authorization.
ST – Requires other selected drugs to be tried first.
QL – This drug has quantity limits on amount covered.
SPRx – Specialty drug; many plans require you to get this type of drug from a Preferred Specialty Pharmacy.
1 Cameron Hill Circle | Chattanooga, TN 37402 | bcbst.com
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or health status in the administration of the plan, including enrollment and benefit determinations.
BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.
BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace.
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