Monday, May 24, 2010

BCBSNC to implement prior certification and restricted access drug changes

Effective July 1, 2010, Blue Cross and Blue Shield of North Carolina (BCBSNC) is implementing changes to their prior review/certification and restricted access drug lists.

The changes include:
The following injectable drugs, covered under BCBSNC medical benefits, will now require prior review by BCBSNC and written certification from a prescribing physician:
• Synagis® (palivizumab), used to prevent respiratory syncytial virus (RSV) prophylaxis in infants and children at risk
• Actemra® injections (tocilizumab), used to treat rheumatoid arthritis
• Stelara® injections (ustekinumab), used to treat psoriasis

The following angiotensin receptor blockers (ARBs), used most often for hypertension and covered under BCBSNC pharmacy benefits, are being added to the restricted-access drug list and will also require written certification from a prescribing physician:
• Atacand®, Atacand-HCT®, Avapro®, Avalide®, Benicar®, Benicar-HCT®, Teveten®, and Teveten-HCT®

The above ARBs will also move from Tier 2 to Tier 3, effective July 1, 2010. If the non-preferred ARB is authorized for them, members will pay a Tier 3 copayment.

Communication to Members and Providers
BCBSNC will mail letters to impacted members in late May. Click to access the Sample Member Letters. BCBSNC providers were notified of these changes in April.

Please note that most infants and very young children who receive Synagis® for one RSV season will not require it for a second season. Using past claims to identify patients who may require RSV prophylaxis for the upcoming RSV season will not be effective. For this reason, BCBSNC will not send letters to affected patients’ or patients’ caregivers.

Questions
Members with questions regarding these changes can contact their Senn Dunn Account Manager or call BCBSNC Customer Service at the toll-free number listed on their ID card.

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