Pharmacy Benefit Changes Effective January 1, 2016

We want to inform you that effective January 1, 2016, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will exclude coverage of some products that are not approved by the U.S. Food and Drug Administration (FDA), as well as change the tier status of some drugs.

Non-FDA Approved Topical Pain Products

Members are being notified by Blue Cross NC this month to inform them that the non-FDA approved topical pain product(s) they currently take (prescription filled within the last six months) will be excluded from coverage as of January 1, 2016.

Changes apply to commercial group and individual members who have their pharmacy benefits through Blue Cross NC. Changes will not impact State Health Plan, Federal Employee Program or Blue Medicare^SM members.

Drug Tier Changes Effective January 1, 2016

Effective January 1, 2016, Blue Cross NC will change the tier status of some drugs on our prescription drug formularies. Blue Cross NC reviews its prescription drug formularies and makes tier status changes based on the availability of drugs (both brand-name and generic drugs) in the market. These changes help us provide our members with access to drugs that are safe, effective and as cost-efficient as possible.

Members are being notified this month about any specific drugs they currently take (prescription filled within the last four months) that will change tier status as of January 1, 2016.

Working Together to Control Rising Rx Costs

Many of the drug utilization management changes we will be making in 2016 to help control the skyrocketing costs of prescription drugs will help us continue to offer sustainable health plans to our customers over the long term. Ongoing programs such as prescription drug utilization management and formulary management help provide our members with access to drugs that are safe, effective and as cost-efficient as possible.

Blue Cross NC is committed to helping members get the most appropriate medications for their specific health care needs. Blue Cross NC regularly reviews medical research and costs of medications, and our clinical staff uses this information to make sure we cover the most effective medicines while keeping costs as affordable as possible.  We encourage our members to talk to their prescribers and pharmacists to determine if lower-cost medications may better meet their needs. Members and providers can find more information about Blue Cross NC’s prescription drug coverage and costs on our website.