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Update to Orencia, Rituxan and Actemra Prior Review Programs

Release Date: December 12, 2012

Beginning February 1, 2013, Blue Cross and Blue Shield of North Carolina (BCBSNC) will be updating our requirements for the medications Orencia, Rituxan and Actemra.  These drugs which currently require prior review will also require the utilization of Remicade prior to Orencia, Rituxan or Actemra being approved for new users.  The detailed criteria for these medications can be found online at

Many infusible agents are used today to treat rheumatoid arthritis (RA) and other inflammatory conditions. BCBSNC has decided to use Remicade as our drug of choice because it has been well studied and found to frequently provide adequate treatment to those with RA.

These medical policy changes will apply to all commercial members who have medical benefits with us, including the State Health Plan.   These changes will not apply to Federal Employee Program, Medicare Advantage and Medicare Part D members.

If you have any questions, please contact our BCBSNC Provider Service Associates at 1.800.777.1643, or BCBSNC Customer Service via the Provider Blue LineSM at 1.800.214.4844.