Rx Utilization Management Changes Effective August 1, 2013
We want to inform you about the following new pharmacy utilization management requirements that will be effective August 1, 2013.
Zytiga, which is a medication used to treat patients with metastatic castration-resistant prostate cancer, will require prior review for NEW users.
Xtandi, which is also a medication used to treat patients with metastatic castration-resistant prostate cancer, will require prior review for NEW users. Additionally, Zytiga must be tried first before Xtandi will be approved for the member.
The detailed approval criteria for both of these medications can be found online at www.bcbsnc.com/umdrug.
These utilization management changes are effective August 1, 2013. These changes will apply all commercial members who have their pharmacy benefits with us, but will not impact the State Health Plan or any ASO employer groups that carve out their pharmacy benefits to another pharmacy benefits manager. Neither of these changes will apply to the Federal Employee Program or Medicare Part D members.
If you have any questions, please contact the Provider Blue LineSM at 1.800.214.4844.