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Pharmacy Program Utilization Management Updates Effective October 1, 2022 July 01, 2022 Pharmacy

Effective October 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will apply the following new requirements to our pharmacy utilization management for the below listed drugs.  

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 MEDICATIONREQUIREMENT 
NexavarThis medication will require Prior Authorization on all formularies. For current members on therapy, generic Nexavar will not require review.  

Updated Requirements
IMPACTED MEDICATIONREQUIREMENT
Prolate This medication will require Step therapy on all formularies. Preferred products include generic oxycodone/acetaminophen tablets, Percocet tablets, and Endocet tablets. 

Formulary Changes
IMPACTED MEDICATIONCHANGE TO FORMULARY
Testosterone 1.62% gel 40.5mg/2.5g packet and 20.25mg/1.25g packet These medications will be removed from the Essential Formulary. Testosterone gel 1.62% pump bottle will be preferred. 
Imbruvica 140 mg tabletsThis medication will be removed from the Essential Formulary. Imbruvica 140 mg capsules will be preferred. 

If you have any questions, please call the Provider Blue Line℠ at 800-214-4844. 
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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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