Important News2010 Medicare Part D Formulary Coverage ChangesFor the upcoming plan year 2010, Blue Cross and Blue Shield of North Carolina (BCBSNC) will be making some changes to the BlueMedicare HMOTM, BlueMedicare PPOTM and BlueRXTM Part D formularies, including the administrative process regarding coverage of certain drugs. More information, including coverage review criteria and fax request forms, can be found at www.bcbsnc.com/content/providers/blue-medicare-providers. Prior Authorization: Effective 1/1/2010, prior authorization will be required for the following drugs and drug classes:
Step Therapy: Also effective 1/1/2010, coverage of non-preferred proton pump inhibitors and intranasal steroids will require step therapy. Going forward, reimbursement of non-preferred drugs in these categories will be considered only after a member’s physician certifies in writing to BCBSNC that the member has previously used a preferred proton pump inhibitor or intranasal steroid and such drug was ineffective in treating the condition or was detrimental to the member’s health. Fax request forms can be found www.bcbsnc.com/content/providers/blue-medicare-providers.
*Only the non-preferred drugs listed are subject to physician certification requirement. Quantity Limitations: In addition, a number of drugs will have quantity limitations in plan year 2010. These quantity limits follow dosing guidelines for each drug approved by the Food and Drug Administration (FDA). The full list of drugs with quantity limitations can be found on www.bcbsnc.com/content/providers/blue-medicare-providers. If you have questions or need more information, please contact your BCBSNC Network Management representative. |