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Rx Prior Review and Quantity Limit Changes for July 1

As of July 1, 2012, prior review will be required and quantity limitations will apply for diclofenac potassium for oral solution (Cambia) for ALL users. The detailed criteria for review of this medication in the use of acute treatment of migraines can be found online at www.bcbsnc.com.

Also as of July 1, 2012, prior review will be required for statins for NEW users. The list of impacted medications and detailed criteria for review of usage in treatment of dyslipidemia can be found online at www.bcbsnc.com.  “New users” are defined as those Blue Cross and Blue Shield of North Carolina members who have not taken an impacted statin in the past 90 days, or who have no claims history showing the use of said statin. 

These pharmacy utilization management changes will apply all commercial members who have their pharmacy benefits with us.  These changes will not apply to State Health Plan, Federal Employee Program, Medicare Part D members, or for any ASO employer groups that carve out their pharmacy benefits to another pharmacy benefits manager.

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