Thursday, September 6, 2012

BCBSNC: Pharmacy Changes Effective October 1

Blue Cross Blue Shield of North Carolina (BCBSNC) is expanding its utilization management (UM) programs for members with medical and pharmacy benefits effective October 1, 2012. These programs require prior review and have quantity limitations.

Medications that require prior review and have a quantity limitation:
  • Dificid
  • Qutenza
Medications that require prior review:
  • Drugs treating hereditary angioedema including Firazyr, Cinryze, Kalitor, and Berinert.
  • H.P. Acthar Gel
Medication that requires a quantity limitation:
  • OxyContin
For futher information please click here.

BCBSNC: New Health and Wellness Programs

Beginning January 1, 2013, Blue Cross Blue Shield of North Carolina (BCBSNC) will implement numerous changes to their health management programs making them more data-driven, results-oriented, and measureable.

BCBSNC will be replacing their previous wellness program, Blue Points with the new Healthy Outcomes. Healthy Outcomes is a fully-integrated management solution that emcompasses more than just wellness. It manages all aspects of a member's health:

  • Healthy Outcomes Case Management- including personal outreach for at-risk individuals.
  • Healthy Outcomes Condition Care- a disease management program.
  • Healthy Outcomes Wellness- a range of structured, virtually turnkey wellness programs.
There are many changes happening with this introduction of Healthy Outcomes. By discontinuing certain programs, enhancing others, and investing in new ones that provide better data to employers, BCBSNC is confident they can make improvements to the cost and health equation.

For more information please view one of the following Health Care Program Transition Guides:

BCBSNC teams up with Key Physicians to create a better patient experience

Last week Blue Cross Blue Shield of North Carolina (BCBSNC) issued a press release regarding the new Accountable Care Organization (ACO) that they are launching with Key Physicians. Key Physicians is an independent, nationally accredited patient-centered medical home network in Wake County. The collaboration will improve the primary care experience for thousands of BCBSNC customers in Wake County and surrounding areas.