Effective January 1, 2022, 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).
New Requirements
| Impacted Medication | Requirement |
|---|---|
| Adderall XR | This medication will require Step Therapy on the Enhanced formulary. The generic formulation will be preferred over the Brand. |
Updated Requirements
| Impacted Medication | Requirement |
|---|---|
| Palynziq | This medication will require Step Therapy with a trial of generic Kuvan prior to approval. |
| Promacta | This medication will require Quantity Limits. |
If you have any questions, please call the Provider Blue Line at 800-14-4844.
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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