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.
|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