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Rx Utilization Management Changes for Spring 2014

We want to inform you about two new pharmacy utilization management changes that will apply to all commercial members who have their pharmacy benefits with us.  These changes apply to the following: 

  • Hepatitis C Program:  We have updated our pharmacy utilization management criteria for Olysio and Sovaldi as of April 16, 2014, to reflect changes in hepatitis C guidelines.  Please refer to our website for more information about these changes.

 

  • Itraconazole:  As of June 1, 2014, up to two preferred agents must be tried before approval can be given for a nonpreferred agent for members whose benefit plans include our Basic Open formulary.  Click on Find a Drug at the top of the bcbsnc.com home page for formulary information.

Again, these 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. 

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.