Prescription Drug Program Changes Effective April 1, 2011 [All Markets]
To encourage safe, cost-effective medication use and help control pharmacy trends, Blue Cross and Blue Shield of Illinois (BCBSIL) is making the following prescription drug benefit program changes effective April 1, 2011.
Formulary Changes Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some revisions will be made to the BCBSIL formulary effective April 1, 2011. Brand Medications Moving to Highest Out-of-Pocket Payment Level Effective April 1, 2011 Formulary Brand Non-Formulary Brand* Condition Generic Alternative(s) Alternative(s)*
N/A = not applicable *Third-party brand names are the property of their respective owners.
†This list is not all-inclusive. Other medications may be available in this drug class.
‡ BCBSIL offers preferred glucose meters (Bayer and Roche) at no additional charge. Members who wish to obtain a Roche ACCU-CHEK® meter should call 1-888-355-4242; members who wish to obtain a Bayer CONTOUR® or BREEZE®2 meter should call 1-877-229-3777.
In addition to the drugs listed in the table above, the following products will also be removed from the formulary effective April 1, 2011:
These products are all available over-the-counter.
Targeted mailings were sent to members affected by the formulary changes per our usual process of notifying members at least 60 days prior to implementation.
Dispensing Limits The prescription drug benefit includes coverage limits on certain medications. These limits are in accordance with generally accepted pharmaceutical and manufacturer’s guidelines. Drug dispensing limits help encourage medication use as intended by the U.S. Food and Drug Administration. As of April 1, 2011, dispensing limits will be placed on medications in the categories in the table below. Drug Dispensing Limit Additions Effective April 1, 2011 Drug Class* Dispensing Limit Acne Epiduo Anticoagulant Pradaxa Antifungal Lamisil Anti-Infective
Tobi Diabetes Glucose Test Strips/Disks Muscle Relaxant Zanaflex Narcotic Butrans Nausea and Vomiting Zuplenz Pulmonary Hypertension Letairis Ulcer/GERD Prevacid *Third-party brand names are the property of their respective owners. †Total quantity of medication in this drug class covered per the indicated days’ supply.
Targeted mailings were sent to members affected by the dispensing limits changes per our usual process of notifying members at least 60 days prior to implementation.
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N/A = not applicable *Third-party brand names are the property of their respective owners.
†This list is not all-inclusive. Other medications may be available in this drug class.
‡ BCBSIL offers preferred glucose meters (Bayer and Roche) at no additional charge. Members who wish to obtain a Roche ACCU-CHEK® meter should call 1-888-355-4242; members who wish to obtain a Bayer CONTOUR® or BREEZE®2 meter should call 1-877-229-3777.
In addition to the drugs listed in the table above, the following products will also be removed from the formulary effective April 1, 2011:
These products are all available over-the-counter.
Targeted mailings were sent to members affected by the formulary changes per our usual process of notifying members at least 60 days prior to implementation.
Dispensing Limits