BCBSNC's Pharmacy Program Changes Effective May 2012

Topical Retinoid Program Revised, New Drugs Added to Current Programs

Blue Cross Blue Shield  of North Carolina (BCBSNC) made the following changes to their pharmacy program.

• Topical Retonoid Prior Plan Approval Program (Providers were notified of these changes on May 9.)
• Adapalene products (Adapalene e.g. Differin; Adapalene/benzoyl peroxide e.g. Epiduo) – the age restriction was removed. Members will continue to be required to try a generic before they can use one of these brand drugs.
• Tazarotene (Tazorac) – the age restriction was changed from age 25 to 35.  Patients aged 35 and younger who have recent claims history of obtaining a generic tretinoin product will not require review.
• Tretinoin products (Tretinoin e.g. Retin-A, Tretin-X, Avita, Atralin; Tretinoin microsphere e.g. Retin-A Micro/Pump; Tretinoin/clindamycin phosphate gel e.g. Veltin, Ziana; Tretinoin bulk powder) – the age restriction was changed from age 25 to 35.  Patients aged 35 and younger with a current prescription for generic topical tretinoin or who have recent (within the past 365 days) claims history of obtaining a generic tretinoin product will not require review.
• Subsys is a new drug that was added to the transmucosal fentanyl program.  It is a fentanyl drug in a spray form. 
• Qnasl is a new drug that was added to the restricted access list of intranasal steroids. 
• Provigil: this drug now has a generic, and both the brand AND generic will require prior plan approval.