Physicians/Specialists
Facilities/Hospitals
Pharmacy
Publication Date: 
2021-01-01

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 here.

 

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 LineSM at 1-800-214-4844.

Drug names are the trademarks of their respective owners.