Monday, June 4, 2012

BCBSNC announces quantity limit changes and tier changes to take effect July 1

Blue Cross and Blue Shield of North Carolina (BCBSNC) is expanding its utilization management program for members with pharmacy benefits effective July 1, 2012.  These programs include prior review and quantity limit programs.  
Programs with changes for ALL users:
Prior review and quantity limitations will be required for:
  • Cambia™ (diclofenac potassium for oral solution) – used to treat acute migraines
Programs with changes for NEW users:
The following brand statins (drugs used to lower cholesterol) will require prior review for new users:
  • Crestor®1 5mg / 10 mg / 20 mg Crestor 40 mg will not be included in this program because it is the highest available dosage / potency of any statin on the market, and it is typically not used as a starting dose, which is what this program is targeting.
  • Vytorin ®1
  • Simcor ®1
  • Livalo ®1
  • Advicor ®1 
  • Lescol ®1  / Lescol XL ®1
  • Lipitor ®1 
Other changes:
Vytorin and Simcor will move from tier 2 to tier 3 on BCBSNC’s drug formulary.
Additional Resources 

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