Tag Archives: formulary

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.

CIGNA Opioid-related formulary changes

A communication is being sent to impacted Cigna clients in the next few days to announce updates on our July 2018 formulary changes.

Pharmacy costs are currently the number one driver of client expenses under both pharmacy and medical benefits.1 At the same time, opioid abuse continues to be a U.S. public health crisis according to the Department of Health and Human Services.2 To address these issues, Cigna’s formulary strategy will be updated to maintain high clinical value while continuing to use a low net drug cost approach to manage coverage for costly branded drugs. At the same time, we will build upon current steps to administer prescription drug coverage in a manner that promotes safe opioid use.

Effective July 2018* our formularies will be updated and Cigna will implement tighter utilization management around the use of opioids.

Customers (employees and dependents) affected by these changes (estimated to be less than 1% of customers3) will also receive a letter from Cigna in early April informing them of the change. Depending on the change, the letters contain steps to work with their doctor to find covered alternatives, prescribe lower quantity levels or apply for drug coverage approval through Cigna’s prior authorization process.

  • Click here to read a summary of Cigna’s July 2018 formulary changes.

Click the following links to view detailed (drug specific) changes for each of Cigna’s formularies. Clients will be sent the above summary and one of the flyers below based on their formulary:

Blue Choice SC Formulary Changes

This is an announcement from Blue Choice:

BlueChoice HealthPlan continually evaluates our prescription drug formularies and drug management programs to ensure effective management of quality and costs. We work with a group of independent doctors and pharmacists to assess our pharmacy programs and get recommendations.

Based on the group’s feedback, BlueChoice® will make minimal changes to theformularies, Prior Authorization and Quantity Management programs. All changes go into effect Jan. 1, 2018, unless noted otherwise. These changes apply to the BlueChoice Tiered Prescription Drug List for our large group and CarolinaADVANTAGE plans. We will send this communication to our group administrators to notify them of the changes.

Blue Choice Pharmacy Changes for 10/1

blue cross blue shield of South Carolina

Pharmacy Changes Effective Oct. 1

BlueChoice HealthPlan continually evaluates our prescription drug formularies and drug management programs to ensure effective management of quality and costs. We work with a group of independent doctors and pharmacists to evaluate our pharmacy programs and get recommendations.

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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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