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Formulary changes
The chart below indicates current and future changes to the formulary used by Blue Medicare HMO, Blue Medicare PPO and Blue Medicare Rx. These changes may include the removal of a drug from the formulary or a change in copayment or coinsurance level. Changes will be posted 60 days before a change takes place and will remain displayed until the revised formulary is published on an annual basis.
| Drug Name | Change Type | Reason for Change | Alternative Options | Estimated Cost of Alternative |
|---|---|---|---|---|
| Bacteriostatic Sodium Chloride 0.9% vial | Removed from formulary | Medicare no longer covers this drug/product under Medicare Part D. | Please ask your doctor to prescribe a drug that is on the formulary (drug list) to treat your condition. Otherwise, you will pay the full cost of this medication. | |
| Nitro-time sustained-action capsule 2.5 mg | Removed from formulary | Medicare no longer covers this drug/product under Medicare Part D. | Nitroglycerin patches may be an alternative. Please ask your doctor to consider and prescribe this drug or another drug that is on the formulary (drug list) to treat your condition. Otherwise, you will pay the full cost of this medication | Generic nitroglycerin patches are covered at the Tier 1 cost-sharing amount. However, your drug costs will depend on your specific prescription drug plan. |
| Nitro-time sustained-action capsule 9 mg | Removed from formulary | Medicare no longer covers this drug/product under Medicare Part D. | Nitroglycerin patches may be an alternative. Please ask your doctor to consider and prescribe this drug or another drug that is on the formulary (drug list) to treat your condition. Otherwise, you will pay the full cost of this medication | Generic nitroglycerin patches are covered at the Tier 1 cost-sharing amount. However, your drug costs will depend on your specific prescription drug plan. |
| Nitroglycerin sustained-action capsule 9 mg | Removed from formulary | Medicare no longer covers this drug/product under Medicare Part D. | Nitroglycerin patches may be an alternative. Please ask your doctor to consider and prescribe this drug or another drug that is on the formulary (drug list) to treat your condition. Otherwise, you will pay the full cost of this medication | Generic nitroglycerin patches are covered at the Tier 1 cost-sharing amount. However, your drug costs will depend on your specific prescription drug plan. |
| Phenazopyridine tablet 100 mg | Removed from formulary | Medicare no longer covers this drug/product under Medicare Part D. | Please ask your doctor to prescribe a drug that is on the formulary (drug list) to treat your condition. Otherwise, you will pay the full cost of this medication. | |
| Pyridium tablet 100 mg | Removed from formulary | Medicare no longer covers this drug/product under Medicare Part D. | Please ask your doctor to prescribe a drug that is on the formulary (drug list) to treat your condition. Otherwise, you will pay the full cost of this medication. |
Blue Medicare HMO and Blue Medicare PPO plans are offered by PARTNERS National Health Plans of North Carolina, Inc., a subsidiary of Blue Cross and Blue Shield of North Carolina (BCBSNC). PARTNERS is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. Plans are administered by BCBSNC. BCBSNC and PARTNERS do not discriminate based on color, gender, religion, national origin, age, race, disability, handicap, sexual orientation, genetic information, source of payment or health status as defined by the Centers for Medicare & Medicaid Services (CMS). All qualified Medicare beneficiaries may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or another third party. BCBSNC and PARTNERS are independent licensees of the Blue Cross and Blue Shield Association.
The information on this page regarding Blue Medicare Rx Plans is current as of 08/17/07.
®, SM Mark of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina.
The information on this page is current as of 07/23/08.