Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Back
Pharmacy Program Updates Effective April 1, 2021 February 15, 2021 Pharmacy

Effective April 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:

New Requirements

Impacted Medications

Requirement

  • Oxycontin

Updated Quantity Limits on Oxycontin 60mg and 80mg from 4 tablets to 2 tablets per day.  This aligns with other Oxycontin strengths.

  • Carafate Suspension
  • Sucralfate Suspension
  • Nitrofurantoin Suspension
  • Furadantin Suspension

These drugs will require Prior Authorization (only for members greater than 11 years old)

  • Sorilux
  • Calcipotriene 0.005% foam (generic Sorilux)
  • Procysbi

These drugs will require Prior Authorization & Step Therapy

  • Keveyis
  • Copaxone
  • Northera

These drugs will require Prior Authorization, Step Therapy, and Quantity Limits

  • Oxervate

This drug will require Prior Authorization & Quantity Limits

  • Sucraid

This drug will require Prior Authorization & Quantity Limits

  • Thiola
  • Thiola EC
  • Syprine
  • Trientine
  • Clovique
  • Depen

These drugs will require Prior Authorization & Step Therapy

  • Austedo
  • Xenazine
  • Tetrabenazine

These drugs will require Quantity Limits (they have and will continue to require PA)

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.

Information in other languages: Español   中文   Tiếng Việt   한국어   Français   العَرَبِيَّة   Hmoob   ру́сский   Tagalog   ગુજરાતી   ភាសាខ្មែរ   Deutsch   हिन्दी   ລາວ   日本語

© 2025 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.