Blue Choice adjust Rx formulary

Prescription Drug Changes

BlueChoice HealthPlan of South Carolina offers pharmacy benefit programs that provide the highest level of clinical effectiveness and safety for the lowest net spend. A group of network doctors and pharmacists who serve on our Pharmacy and Therapeutics Committee chooses the drugs that are preferred on our Prescription Drug List (PDL). This group also chooses drugs for our Specialty Drug List and approves decisions about our drug management programs, including which drugs will be subject to prior authorization, quantity management and step therapy. They base their decisions on a drug’s effectiveness, safety and value.

Based on their feedback, we will make changes to the PDL and drug management programs effective January 1, 2014. These changes apply to all fully insured groups and self-funded groups that have our pharmacy benefits.

Preferred Drug List Changes

Moving from Preferred to Non-Preferred (due to generic launches)
These drugs are moving to non-preferred status due to the release of a generic equivalent. We typically move preferred drugs to non-preferred when a generic becomes available. However, we do not routinely send target member letters when this occurs. Most members are pleased that their drug is now available at a lower cost, as evidenced by our 81 percent generic dispensing rate!

Brand Name moving to tier 3 Generic Equivalent Used to treat
Metrogel topical metronidazole Rosacea
Niaspan niacin High Cholesterol
Prandin repaglinide Diabetes
Retin A Micro tretinoin Acne
Soriatane acitretin Psoriasis
Temodar temozolomide Cancer
Zemplar paricalcitol Hyperparathyroidism
Zymaxid gatifloxacin Conjunctivitis

Communications Plan: No member letters will be sent. These changes affect a small proportion of members.

Moving from Preferred to Non-Prefered

Non-Preferred Generic or Preferred Alternatives Used to treat
Byetta Bydureon, Victoza Diabetes
Crestor atorvastatin High Cholesterol
Vytorin atorvastatin High Cholesterol

Communications Plan: Impacted members will be sent a letter on or around November 1, 2013.

Moving from Non-Preferred to Preferred

Non-Preferred Moving to Preferred Used to treat
Baraclude Hepatitis B

Communications Plan: No target member letters will be sent.

Prior Authorization Changes
Beginning January 1, 2014, the following drugs – bolded and underlined – will be added to the prior authorization program.  Some of them are already in categories where prior authorization already exists. Prior authorizations for these drugs require, in addition to other documentation, that members have tried at least one alternative drug before the PA drug will be approved.

Drugs requiring PA Condition Alternatives
Avalide, Atacand, Atacand HCT, Avapro, Cozaar, Diovan HCT, Edarbi, Edarbyclor, Hyzaar, Tekturna, Tekturna HCT, Teveten, Teveten HCT High Blood Pressure Candesartan, candesartan/hydrochlorothiazide, eprosartan, irbesartan, irbesartan/hydrochlorothiazide, losartan, losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide, Benicar,              Benicar HCT, Diovan
Crestor*, Vytorin* High Cholesterol (High Potency) atorvastatin
Altoprev, Lescol, Lescol XL, Lipitor, Livalo, Mevacor, Pravachol, Zocor High Cholesterol atorvastatin, fluvastatin, lovastatin, pravastatin, simvistatin
Insulins:  All Apidra, Humalog and Humulin  (except Humulin U-500) Diabetes                (insulin) Novolog, Novolin
Kazano, Nesina, Oseni, Tradjenta, Jentadueto Diabetes             (DPP-4) Januvia, Janumet, Janumet XR, Kombiglyze,  Onglyza
Rayos Corticosteroids immediate-release prednisone
Breo Ellipta Asthma, COPD Advair, Symbicort

*Members taking Crestor 40mg or Vytorin 10/80mg will be grandfathered and not subject to the PA. However, they will have a tier change.

Member Impact and Communications Plan:
Diovan HCT (brand only): We will send a letter to impacted members on or around November 1.
Crestor, Vytorin: We will send a letter to impacted members on or around November 1. This letter addresses both the PA and the tier change for this group of members.
Lescol, Lescol XL, Lipitor, Mevacor, Pravachol, Zocor (brand only): We will send a letter to impacted members on or around November 1.
Rayos: We will send a letter to impacted members on or around November 1.
Apidra: We will send these members a letter on or around November 1 and then again on December 15.
DPP-4s: Current members (fewer than 30) will be grandfathered; therefore no letters will be sent.
Breo Ellipta: The product is not on the market yet, so no member impact yet/no letters sent.

Step Therapy Changes
Beginning January 1, 2014, Fabior is being added to the current step therapy criteria for acne.

You must first try one of these drugs or your doctor must request an exception for you … Used to treat … before you can get coverage for these drugs
First Choice Drugs Second Choice Drugs
generic topical tretinoin Acne Atralin, Avita, Differin, Fabior, Retin-A, Retin-A Micro,  Tazorac, Tretin-X, Veltin or Ziana

Communications Plan: There are two current users.  We will send a letter to impacted members on or around November 1.

Additions to the Specialty Drug List
Beginning January 1, 2014, the drugs listed will be added to the Specialty Drug List. Members who have a specialty drug benefit (most BlueChoice members) will pay a specialty copayment for these drugs, starting in January. They will also be required to use Accredo*, our preferred specialty pharmacy, to fill these drugs. Accredo is an independent company that provides specialty pharmacy services on behalf of BlueChoice®.

*On November 11, 2013, our current preferred specialty pharmacy will merge with another specialty pharmacy, Accredo. The new company will be called Accredo after November 11.

Drug Name Used to treat PA Added?
Bexxar Non-Hodgkins lymphoma No
Gilotrif Non-small cell lung cancer No
Mekinist Melanoma No
Rixubis Hemophilia B No
Simponi Aria Rheumatoid arthritis Yes
Tafinlar Melanoma No
Valchlor Cutaneous T-cell lymphoma No
Xofigo Prostate cancer No

Communications Plan: No members are impacted at this time. Therefore no letters will be sent.

Additions/Deletions to Specialty Drug List Prior Authorizations
Prior authorizations are being added to several specialty drugs, per this table:

Drug Name Used to Treat Implementation for Current Member Implementation for New Members
Tecfidera Pulmonary Hypertension Grandfather for life January 1, 2014
Incivek, Victrelis Hepatitis B Grandfather until December 31, 2014 January 1, 2014

Communications Plan: No letter will be sent because there is no member impact at this time

Prior authorizations are being deleted for these specialty drugs, effective January 1, 2014:

Drug Name Used to Treat
Iron Replacement (i.e. Feraheme, Venofer) Iron-deficiency Anemia
Boniva IV Osteoporosis

Communications Plan: This is a positive change. Therefore no letters will be sent.