Formulary changes
The chart below indicates current and future changes to the formulary used by Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx. These changes may include the removal of a drug from the formulary or a change in copayment or coinsurance level. Changes will be posted 60 days before a change takes place and will remain displayed until the revised formulary is published on an annual basis.
| Drug Name | Change Type | Reason for Change | Alternative Options | Estimated Cost of Alternative |
|---|---|---|---|---|
| Valturna | This product has been removed from the formulary. | This product has been withdrawn or discontinued by the manufacturer. | Please ask your doctor to prescribe a product that is on the formulary (drug list) to treat your condition. | Your drug cost will depend on your specific prescription drug plan and the formulary alternative prescribed by your doctor. |
| Ganciclovir capsule | This product has been removed from the formulary. | This drug has been withdrawn or discontinued by the manufacturer. | Please ask your doctor to prescribe a drug that is on the formulary (drug list) to treat your condition. | Your drug cost will depend on your specific prescription drug plan and the formulary alternative prescribed by your doctor. |
| Tropicamide ophthalmic solution | This drug has been removed from the formulary. | This drug is used for diagnostic purposes and Medicare no longer covers it under Medicare Part D. | Please ask your doctor to prescribe a drug that is on the formulary (drug list) to treat your condition, if needed. | Your drug cost will depend on your specific prescription drug plan and the formulary alternative prescribed by your doctor. |
| Ergotamine-caffeine tablet | This drug has been removed from the formulary. | This drug has been withdrawn or discontinued by the manufacturer. | Please ask your doctor to prescribe a drug that is on the formulary (drug list) to treat your condition. | Your drug cost will depend on your specific prescription drug plan and the formulary alternative prescribed by your doctor. |
| Vicodin HP tablet 10-660 mg | This drug has been removed from the formulary. | This drug has been withdrawn or discontinued by the manufacturer. | Please ask your doctor to prescribe a drug that is on the formulary (drug list) to treat your condition. | Your drug cost will depend on your specific prescription drug plan and the formulary alternative prescribed by your doctor. |
| Budeprion XL | This drug has been removed from the formulary. | This drug has been withdrawn or discontinued by the manufacturer. | Please ask your doctor to prescribe a drug that is on the formulary (drug list) to treat your condition. | Your drug cost will depend on your specific prescription drug plan and the formulary alternative prescribed by your doctor. |
| Zuplenz oral film | This drug has been removed from the formulary. | This drug has been withdrawn or discontinued by the manufacturer. | Please ask your doctor to prescribe a drug that is on the formulary (drug list) to treat your condition. | Your drug cost will depend on your specific prescription drug plan and the formulary alternative prescribed by your doctor. |
Blue Cross and Blue Shield of North Carolina (BCBSNC) is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. BCBSNC does not discriminate based on color, gender, religion, national origin, age, race, disability, handicap, sexual orientation, genetic information, source of payment or health status as defined by the Centers for Medicare & Medicaid Services (CMS). All qualified Medicare beneficiaries may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or another third party. BCBSNC is an independent licensee of the Blue Cross and Blue Shield Association.
The information on this page regarding Blue Medicare Rx Plans is current as of 08/17/07.
®, SM Mark of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina.
The information on this page is current as of 05/01/13.
© , Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.