Pharmacy Program Updates Effective April 1, 2021
February 15, 2021
Effective April 1, 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will have changes to our pharmacy utilization management (UM) requirements.
Our UM requirements apply to all commercial members with pharmacy benefit coverage through Blue Cross NC. These changes do not affect State Health Plan, Federal Employee Program, Medicare Part D members or any self-funded employer groups that carve out pharmacy benefits to another pharmacy benefits manager (PBM).
Below is a summary of the changes:
New Requirements
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| Impacted Medications | Requirement |
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Updated Quantity Limits on Oxycontin 60mg and 80mg from 4 tablets to 2 tablets per day. This aligns with other Oxycontin strengths. |
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These drugs will require Prior Authorization (only for members greater than 11 years old) |
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These drugs will require Prior Authorization & Step Therapy |
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These drugs will require Prior Authorization, Step Therapy, and Quantity Limits |
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This drug will require Prior Authorization & Quantity Limits |
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This drug will require Prior Authorization & Quantity Limits |
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These drugs will require Prior Authorization & Step Therapy |
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These drugs will require Quantity Limits (they have and will continue to require PA) |