Wednesday, February 1, 2012

BCBSNC prescription drug prior review and restricted access changes effective March 1

Blue Cross and Blue Shield of North Carolina (BCBSNC) is expanding its utilization management programs for members with pharmacy benefits with us effective March 1, 2012.  These programs include prior review and restricted access programs.  (Restricted access means members must try a preferred drug before they can receive coverage for a non-preferred drug.)

Changes Affecting ALL users of certain drugs:

Prior review will be required for:
  • Egrifta® (Tesamorelin) – used to reduce excess abdominal fat in HIV-infected patients with lipodystrophy
  • Growth hormones, which will continue to require prior review, will now also be added to the restricted access list
  • Omnitrope® is the preferred drug and must be tried before any other drug is approved.  The following drugs are non-preferred:  Genotropin®, Humatrope®, HumatroPen®, Norditropin Nordiflex®, Norditropin Flexpro®, Nutropin®, Nutropin AQ®, Nutropin AQ Nuspin®, Saizen®, Serostim®, Tev-Tropin® and Zorbitive®.
Changes Affecting NEW users of certain drugs:
  • Renin inhibitors will be added to the restricted access list for new users only. Members must first try a preferred drug before the non-preferred drugs will be approved:  
    • Preferred renin inhibitors: losartan or losartan/HCTZ (Cozaar® or Hyzaar®), (valsartan/amlodipine or valsartan/amlodipine/HCTZ (Exforge® or Exforge HCT®), telmisartan or telmisartan/HCTZ.(Micardis ® or Micardis HCT®), valsartan or valsartan/HCTZ (Diovan® or Diovan HCT®).
    • Non-preferred renin inhibitors: Tekturna®, Tekturna HCT®, Valturna®, Tekamlo™ and Amturnide™.
  • Multiple Sclerosis drugs, which will continue to require prior review, will now also be added to the restricted access list for new users only:
    • Betaseron® or Rebif® are the preferred drugs and must be tried before any other drug is approved.  The following drugs are non-preferred: Extavia® and Avonex®.
Additional Resources
In early February, BCBSNC will send this letter to 206 members who currently take Egrifta, Genotropin, Humatrope, HumatroPen, Norditropin Nordiflex, Norditropin Flexpro, Nutropin, Nutropin AQ, Nutropin AQ Nuspin, Saizen, Serostim, Tev-Tropin or Zorbitive.

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