Pharmacy Program Updates, Effective January 1, 2021
January 1, 2021 Update: We have updated the content below to include new details on preferred insulin options for members. (The original article was posted on Dec. 7, 2020.)
Effective January 1, 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will have changes to our pharmacy utilization management (UM) requirements.
Our UM requirements apply to all commercial members with pharmacy benefit coverage through Blue Cross NC. These changes do not affect State Health Plan, Federal Employee Program, Medicare Part D members or any self-funded employer groups that carve out pharmacy benefits to another pharmacy benefits manager (PBM).
Below is a summary of the changes, and more details can be found on our prescription drug page.
New Requirements
Impacted Medications | Requirement |
|---|---|
| Aplenzin, Forfivo XL, Nexium granules, pantoprazole suspension packets, Tecfidera, and Tecfidera starter kit | These drugs will require Prior Authorization |
| Bydureon, Gleevec, Ozempic, Rybelsus, Trulicity, Victoza, Vumerity | These drugs will require Prior Authorization |
| Minocycline HCL ER and Xhance | These drugs will require Prior Authorization and Step Therapy |
| Zavesca, Xhance, Aplenzin, Wellbutrin XL | These drugs will require Quantity Limits (QL) |
| Concerta, Kombiglyze, Onglyza | These drugs will require Step Therapy |
| Azeschew, Azesco, Trinaz, Zalvit | These prenatal vitamins are benefit excluded – not covered |
| All prescription prenatal vitamins are included in this benefit limitation. Going forward, prenatal vitamins are limited to members that are planning pregnancy, currently pregnant, or breastfeeding. For members who believe they should qualify for an exception, providers can complete the exception form listed on the Pharmacy Prior Review and Limitations page and submit Blue Cross NC for review. | These prenatal vitamins will have a benefit limitation |
Preferred Insulin Options for Members
Effective January 1, 2021, (ONLY) the Essential formulary will prefer the following insulin syringes and pen needles:
- Arkray TechLite Insulin Syringes
- Arkray TechLite Pen Needles
- Trividia TruePlus Insulin Syringes
- Trividia TruePlus Pen Needles
Select members have been informed of the update above. Members will need to switch to either Arkray or Trividia products for 2021. This information is for information purposes only. No additional action from providers required.
If you have any questions, please call the Provider Blue Line℠ at 800-214-4844.
Drug names are the trademarks of their respective owners.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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