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Notification of Specialty Pharmacy Medical Step Therapy Updates (Healthy Blue + Medicare (HMO D-SNP))
Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.
Effective for dates of service on and after December 1, 2023, updated step criteria for Iron Agents found in Clinical Criteria document CC-0182 will be implemented. The preferred product list is being expanded. Please refer to the Clinical Criteria page for more information.
Clinical UM Guidelines are publicly available on the care provider website. Visit the Clinical Criteria page to search for specific criteria.
| Clinical UM Guidelines | Preferred Drug(s) | Nonpreferred Drug(s) |
|---|---|---|
| CC-0182 | Feraheme (ferumoxytol) Ferrlecit (sodium ferric gluconate/sucrose complex) Infed (iron dextran) Venofer (iron sucrose) | Injectafer (ferric carboxymaltose) Monoferric (ferric derisomaltose) |
We’re committed to active involvement with our care provider partners and going beyond the contract to create a real impact on the health of our communities.
For more information, visit our Healthy Blue Medicare page.
Blue Cross and Blue Shield of North Carolina Senior Health, DBA Blue Cross and Blue Shield of North Carolina, is an HMO D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal.
NCBCBS-CR-038910-23-CPN38505 October 2023
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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