Tag Archives: blue cross

Blue Cross Blue Shield SC Formulary Changes

Exclusions for many certain high-cost brand drugs that are no more effective than medications already available are among the latest updates to BlueCross BlueShield of South Carolina’s drug formulary, with most of the changes taking effect July 1, 2018.

We work with an independent panel of BlueCross network physicians and pharmacists, the Pharmacy and Therapeutics Committee, to develop and maintain our drug lists and policies. Clinical decisions are based on drugs’ efficacy, safety and value, with the goal of providing the greatest clinical effectiveness for the lowest cost.

The particular brand-name drugs affected by this update are usually launched a couple of years after a new brand-name drug is introduced. “Structurally, they are very similar to drugs already on the market,” said Joshua Arrington, who is pharmacy sales director for BlueCross as well as a licensed pharmacist.

The newer versions aim to capture their own share of the market as manufacturers promote them as providing additional value. But because they are so similar to the original drugs, they offer no clinical benefit to patients — and after initial discounts wear off, they don’t offer additional cost savings, either.

The new Update Bulletin from our Pharmacy Management department includes an A-to-Z (Aczone to Zofran) list of drugs that will be excluded as of July 1, as well as alternative medications that are covered. Arrington mentioned some examples of the savings involved:

  • Doryx averages $1,000 per prescription. Its generic alternative doxycycline is $18.
  • Amrix averages $1,000 per prescription. Its generic alternative cyclobenzaprine is $10.
  • Gralise averages $660 per prescription. Its generic alternative gabapentin is $15.

Please note that the Pharmacy Management bulletin also includes other drug formulary updates that have taken effect or will take effect soon. They apply to specialty drugs, topical corticosteroids, and some requirements for prior authorization, step therapy and quantity limits.

University Hospital in Augusta, GA Joins Blue Option

blue cross blue shield of South Carolina

BlueChoice HealthPlan and BlueCross BlueShield of SC are pleased to announce that effective Jan. 1, 2017, Blue Option members now have full access for covered services at the University Hospital in Augusta, GA, and approximately 420 of its affiliated physicians and providers. 

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Blue Cross SC drops Walgreens and Rite Aid on October 1

BLUE CROSS drops rite aid and walgreens

Effective October 1, 2016, all Blue Option individual and family plans under the Affordable Care Act (ACA) will be covered by the Advanced Choice Pharmacy Network. This is an exclusive pharmacy network impacting current members, as well as members with new plans sold with effective dates October 1 and beyond. Exclusive pharmacy networks are a necessary step toward controlling prescription drug cost increases that continue to trend upward.

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Blue Cross loses more money on exchange than other carriers

The nation’s Blue Cross and Blue Shield plans have fared worse than publicly traded health insurance companies on the new health insurance exchanges, with many of these plans losing hundreds of millions of dollars last year on individual policies sold under the Affordable Care Act.

A new report from Fitch Ratings, which looked at earnings ofnearly three dozen Blue Cross and Blue Shield companies, showed 23 had a decline in earnings and 16 had a net loss , largely related to losses from policies sold to newly insured Americans who bought subsidized individual policies on public exchanges. There were 23 Blue Cross companies that reported a “collective $1.9 billion decline in earnings” for the first nine months of 2015, and 16 of those companies had net losses.

It’s a significant development because these insurers are raising prices for this year to recover the losses and taking additional steps like slashing broker commissions and narrowing doctor and hospital choices to rebound in 2016.

Blue Cross plans also tend to be the dominant providers of individual policies in their states. In Illinois, for example, the Blue Cross plan owned by Health Care Service Corp. has about 80% of the customers who purchase coverage on the public exchanges.

Obamacare Pummels Blue Cross Blue Shield Of NC–What Can We Learn From This?

Forbes posted an article on January 30, 2016 with this title.  Very scary stuff-

According to this morning’s News and Observer, “The dramatic deterioration in Blue Cross’ ACA business is causing increasing alarm among agents and public health officials.”  In response to its bleak experience with the Obamacare exchange, the company has decided to eliminate sales commissions for agents, terminate advertising of Obamacare policies, and stop accepting applications on-line through a web link that provides insurance price quotes–all moves calculated to limited Obamacare enrollment.”

The losses incurred by Obamacare policies has caused the company to have an overall loss of $50.6 million dollars.  They have not lost money in more than a decade.  Considering that they are the largest carrier in North Carolina, and with United Healthcares’ announcement that they are likely leaving Obamacare as well, this does not bode well for individuals looking to get coverage next year.

Nor does it bode well for the United States’ ability to pay for this law, which has always been in question, and for the future of the law itself.

Read the full article here.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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