Thursday, September 2, 2010

BCBSNC to implement changes to prescription drug prior review and restricted access lists

Effective October 1, 2010, Blue Cross and Blue Shield of North Carolina (BCBSNC) is implementing changes to their prior review/certification and restricted access drug lists in an effort to continue providing high-quality, cost-effective health care. All of the drugs impacted are covered as part of a member’s prescription drug benefit.

All users of the following drugs will be subject to the new prior review/certification requirement:
• Naproxen/esomeprazole (Vimovo ®) – for chronic arthritis conditions in patients at risk of gastric bleeding
• Dalfampridine (Ampyra®) – used to improve walking in patients with multiple sclerosis
• Antinarcoleptic Agents (Provigil®, Nuvigil®) – for certain wake-sleep disorders

New users of the following drugs will be subject to the new prior review/certification requirement:
• Disease-modifying drugs for multiple sclerosis (Betaseron®, Extavia®, Avonex®, Rebif®, Copaxone®)
• Oral drugs for pulmonary arterial hypertension (Letairis®, Tracleer®, Revatio®, Adcirca®
• Cyclosporine ophthalmic (Restasis®) – for moderate to severe dry eyes

Members using one of the nonpreferred brand-name tetracyclines (Doryx® or Solodyn®) will be required to have their physician submit written certification to BCBSNC stating that the member has previously tried at least one of the preferred medications.

Communications to Providers and Members
BCBSNC participating providers were notified of these changes in July. BCBSNC will mail letters to impacted members in early September. Because prior review/certification will only be required for new users of the drugs listed in the second bulleted item above, no member notification will be sent to members who are already taking one of these medications.

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