Tag Archives: South Carolina

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.

Blue Cross Blue Shield SC addresses Opioid Epidemic

From Blue Cross on February 1:

As our state and nation mobilize to address the opioid abuse epidemic, BlueCross BlueShield of South Carolina is committed to doing its part. Starting April 1, 2018, new limits on opioid prescriptions will take effect for all employer groups with BlueCross pharmacy benefits.

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.

Addressing opioid prescriptions specifically, the committee has focused on daily quantity limits and added requirements for prior authorization in some prescribing situations, basing its decisions on guidance from the federal Centers for Disease Control and Prevention.

According to the CDC, there were a record 33,000 U.S. deaths from opioid overdoses in 2015 — nearly half of them involving prescription medications. In 2016, nearly 5 million opioid prescriptions were filled in South Carolina, according to the S.C. Department of Health and Environmental Control.

“There is evidence that the more opioids are prescribed in a given region, the more likely it is that there will be a related increase in addiction and in overdose deaths,” said Dr. Matthew Bartels, BlueCross vice president and chief medical officer. “As this epidemic is addressed at the federal, state and local levels, we are hopeful that our new Opioid Management program will be part of the solution in South Carolina.”

Employers will not be able to opt out of the program. However, patients who have sickle cell disease, are undergoing cancer treatment, or are receiving palliative care or end-of-life care, will be exempt from the program requirements.

For details, please see this Update Bulletin on opioids from our Pharmacy Management department.

Attached to the policy bulletin about opioids is the regular Pharmacy Management Update Bulletin outlining some other drug list revisions. In particular, please note the coverage update affecting medications used to treat hepatitis C.

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Using an IRA Trust

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What is it? What kind of benefit could it provide?

Provided by Reeve Conover, Conover Consulting

Seemingly everyone has heard of an IRA, but few people know about IRA trusts. Perhaps more people should, for an IRA trust may provide a way to “stretch” IRA assets for decades to benefit multiple generations.

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What Does Your Home Insurance Cover?

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Take a moment to see if you are adequately protected.

Provided by Reever Conover – Conover Consulting

Not all home insurance policies are alike. Coverage amounts obviously vary, and so do coverage areas. Taking ten minutes to scrutinize what your policy does (and does not) cover is a wise idea.

Homeowner policies routinely provide tornado, windstorm, & hailstorm coverage. If a tornado, windstorm, or hailstorm damages your home or yard, the insurer will commonly pay out in response to your claim, unless your residence has somehow failed to qualify for such coverage.1,2

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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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