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Rx Utilization Management Changes Effective April 1, 2014

We want to inform you about the following new pharmacy utilization management requirements that will be effective April 1, 2014. 

The following new utilization management requirements will apply to 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. 

Multiple Sclerosis – this program will apply to the Enhanced, Basic Open and Basic Closed formularies

Members who have not previously had an authorization approved for the nonpreferred drugs listed below must try two preferred medications before they will be approved for the nonpreferred medications:


Preferred Medications

  • Preferred Injectable Medications:  Betaseron, Rebif, Copaxone
  • Preferred Oral Medication: Tecfidera

Nonpreferred Medications

  • Nonpreferred Injectable Medications:  Avonex, Extavia 
  • Nonpreferred Oral Medications:  Aubagio, Gilenya  

Please note that if the member wants a nonpreferred oral medication, one of the preferred medications needs to include oral Tecfidera. 

The detailed review criteria for these pharmacy utilization management programs are available online at www.bcbsnc.com/umdrug

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