Publication Date

Publication Date: 
2017-04-11

Blue Cross and Blue Shield of North Carolina’s Blue Medicare PPO Enhanced and Blue Medicare HMO Enhanced plans include a 6-tier prescription drug formulary. Medications in Tier 6 have NO copay.* 

Members can benefit from cost-savings opportunities when they are prescribed a medication in Tier 6.  Although this may seem confusing, as typically higher tiers are associated with higher copays, medications in Tier 6 mean the member will actually pay less. 
 

Tier Tier Name
1 Preferred Generic
2 Generic
3 Preferred Brand
4 Non-preferred Brand
5 Specialty
6 Select Care (generic adherence Medications

 

These Tier 6 medications are limited to select generic medications that are part of the patient safety and quality measures for adherence used by the Centers for Medicare and Medicaid Services (CMS) and adapted from Pharmacy Quality Alliance (PQA). These measures specifically track adherence to certain blood pressure, cholesterol, and diabetes medications. 
 

Star Measure Drug Class Examples Tier 6 Generic Medications**
D12 - Medication Adherence for Diabetes Medications

biguanides, sulfonylureas, thiazolidinediones, meglitinides

glimepiride, glipizide, glipizide ER, metformin, metformin ER, nateglinide, pioglitazone
D13 – Medication Adherence for Hypertension (RAS antagonists) ACE inhibitors, ARBs amlodipine/valsartan, amlodipine/valsartan/HCTZ, benazepril, benazepril/HCTZ, captopril, enalapril, enalapril/HCTZ, fosinopril, irbesartan, irbesartan/HCTZ, lisinopril, lisinopril/HCTZ, losartan, losartan/HCTZ, quinapril, ramipril, telmisartan, telmisartan/HCTZ, valsartan
D14 – Medication Adherence for Cholesterol (statins) statins atorvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin

*When filled at a Blue Medicare preferred retail pharmacy or Walgreens Mail Service, and a low copay at all other participating pharmacies. Members are responsible for the cost of these medications during the coverage gap. 

**For additional information, please refer to the member’s formulary:  http://www.bcbsnc.com/content/medicare/member/policies/approval.htm