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Rx Basic Closed Formulary Changes Effective January 1, 2014

We want to inform you about the following formulary changes on the Basic Closed formulary effective January 1, 2014.  The Basic Closed formulary is paired with our Blue ValueSM and Blue SelectSM plans for members who had either plan as of October 1, 2013, and decided to renew. 

The following medications will be considered nonformulary drugs as of January 1, 2014: 

  • Adoxa
  • Doryx
  • Dynacin
  • Monodox
  • Solodyn
  • Teveten
  • Virbramycin capsules
  • Virbramycin suspension 

Members who have taken these particular medications in the past 90 days will be able to continue to receive them without requiring a nonformulary exception review (criteria and fax form available online). 

If you have any questions, please contact the Provider Blue LineSM at 1.800.214.4844.