Important NewsThree Drugs added to Prior Review list as of July 1Effective July 1, 2009, prior review is required for coverage of alefacept injection (Amevive) and for transmucosal fentanyl (Actiq, Fentora). In order to request coverage for Amevive or for transmucosal fentanyl, providers must complete and fax the appropriate prior review fax form to BCBSNC. The form can be downloaded from our Web site at www.bcbsnc.com via the Provider portal. Amevive Criteria for coverage of Amevive are outlined in a new medical policy that is available online in the "Medical Policy" section. The patient must have moderate to severe plaque psoriasis, be at least 18 years of age, have received phototherapy (or is not a candidate for phototherapy), and have received other systemic treatments for psoriasis before coverage for Amevive will be considered. Please see the medical policy for more detail. If approved, Amevive is covered under BCBSNC's medical benefits. Transmucosal Fentanyl Transmucosal fentanyl formulations will also require prior review for coverage. Drug products containing fentanyl designed to be absorbed through the buccal mucosa include fentanyl citrate lozenges (Actiq and generics) and fentanyl buccal tablets (Fentora). There is no specific medical policy on the use of this drug as the criteria for coverage of transmucosal fentanyl follows FDA-approved indications:
Fentanyl citrate lozenges (Actiq and generics) and fentanyl buccal tablets (Fentora) are covered under BCBSNC's pharmacy benefits. |