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Blue Medicare Rx Medicare Part D Formulary Changes 2011 to 2012

December 1, 2011

The Medicare Part D annual (seven-week) Open Enrollment Period (OEP) began October 15, 2011 and ends on December 7, 2011. On October 6, 2011 the 2012 Blue MedicareRx (BlueCross BlueShield of IL, TX, OK, and NM) Medicare Part D formulary was granted ‘conditional approval’ by the Centers for Medicare and Medicaid Services (CMS). As with all Medicare Part D drug plans, you can expect a number of formulary and utilization management changes for 2012. Some of the changes were mandated by CMS (safety concerns, drugs that no longer meet CMS’ definition of a ‘Part D medication’, etc.) but others were a result of dynamic changes in the pharmaceutical marketplace. The Blue MedicareRx 2012’s Part D formulary changes include addition of some new drug therapies as well as the migration to some important generic equivalents (e.g. LEVAQUIN, ARIXTRA, ENDOCORT EC, NASACORT AQ, FEMARA, XALANTAN, ARICEPT, and LIPITOR) that have and/or will become available in 2011.

A copy of 2011 to 2012 formulary changes (i.e. drug removals and new Prior Authorization and Step Therapy utilization management programs) will be included in the Annual Notice of Change (ANOC) that is sent to all current members of HISC’s Medicare Part D plans. In addition, individual member letters will be mailed by mid-November 2011, alerting them of 2012 formulary changes (removals, tier changes, new utilization management programs, etc.) affecting them. Finally, a copy of the 2012 formulary is already available on the BCBSTX website in time for the start of the Medicare Part D OEP. Please refer to our list below for a handy reference to the Top 30 medications that will be impacted by a change to the 2012 formulary and therefore, have the most potential to affect current members. Coverage determinations for changes, when applicable, can be submitted by the prescribing physician after December 1, 2011 with an effective date of January 1, 2012.

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Formulary Change

2011
Tier

2012
Tier

Description of
Formulary Change

Formulary Alternative
if Applicable

1

ACCOLATE

10mg, 20mg

2

NF

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(zafirlukast)

2

ACTOPLUS MET,
ACTOPLUS MET XR

3

NF

Is not covered on our 2012 formulary

Formulary alternatives available

3

Alfuzosin tabs

10mg

1

NF

Is not covered on our 2012 formulary

Formulary alternatives available (tamulosin, RAPAFLO)

4

ARICEPT, ARICEPT ODT

3

NF

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(donepexil)

5

ARIMIDEX tabs

1mg

3

NF

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(anastrozole)

6

AVONEX

4

4

Is on our formulary, however quantity limits may apply

On formulary, quantity limit may apply

7

BYETTA

3

NF

Is not covered on our 2012 formulary

Formulary alternatives available (VICTOZA)

8

Captopril HCL

1

NF

Is not covered on our 2012 formulary

Generic alternatives available

9

Dexamethasone solution

0.5mg/5ml

3

NF

Is not covered on our 2012 formulary

Formulary alternatives available (dexamethasone elixir)

10

Diphenhydram caps 25mg

2

NF

Is not covered on our formulary because it does not meet the definition of a Part D drug under CMS regulations and will not be considered for coverage determination

Formulary alternatives available (diphenhydramine elixir, 50mg capsule)

11

DUETACT

3

NF

Is not covered on our 2012 formulary

Formulary alternatives available

12

DULERA

3

NF

Is not covered on our 2012 formulary

Formulary alternatives available

(ADVAIR, ADVAIR HFA, or SYMBICORT)

13

EFFEXOR XR

3

NF

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(venlafaxine ER cap)

14

ENBREL

4

4

Is on our formulary, however Prior authorization may apply

On formulary, Prior Authorization may apply

15

EXELON caps

1.5mg, 3mg, 4.5mg, 6mg

2

NF

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(rivastigmine cap)

16

Fenofibrate caps

67mg, 134mg, 200mg

Fenofibrate tabs

54mg, 160mg

1

1

Is on our formulary, however quantity limit may apply

On formulary, quantity limit may apply

17

Gemfibrozil tabs

600mg

1

1

Is on our formulary, however quantity limit may apply

On formulary, quantity limit may apply

18

HUMIRA

4

4

Is on our formulary, however Prior authorization may apply

On formulary, Prior Authorization may apply

19

LEVAQUIN tabs

250mg, 500mg, 750mg

LEVAQUIN/D5%W 250mg/50ml, 500mg/100ml, 750mg/150ml

2/3

1

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(levofloxacin tabs, inj.)

20

LOVENOX inj 100mg/ml, 120mg/0.8ml, 150mg/ml, 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml, 80mg/0.8ml

3/4

1

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(enoxaparin inj.)

21

NIASPAN ER tabs

500mg, 750mg, 1,000mg

2

2

Is on our formulary, however quantity limit may apply

On formulary, quantity limit may apply

22

NITROLINGUAL spray lingual, duo pack, pumpspray

3

NF

Is not covered on our 2012 formulary

Formulary alternatives available (NITROMIST)

23

OXYCONTIN CR tabs

10mg, 15mg, 20mg, 30mg, 40mg

2

2

Is on our formulary, however quantity limit may apply

On formulary, quantity limit may apply

24

RYTHMOL SR caps

225mg, 325mg, 425mg

3

NF

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(propafenone ER caps)

25

SULAR tabs

8mg, 17mg, 25.5mg, 34mg

3

NF

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(nisoldipine)

26

Trandolapril/verapamil CR tabs

1-240mg, 2-180mgmg, 2-240mg, 4-240mg

1

NF

Is not covered on our formulary because it does not meet the definition of a Part D drug under CMS regulations and will not be considered for coverage determination

Formulary alternatives available

27

UROXATRAL tabs

10mg

2

NF

Is not covered on our 2012 formulary

Formulary alternatives available (tamulosin, RAPAFLO)

28

Venlafaxine ER tabs

225mg ONLY

1

NF

Is not covered on our 2012 formulary

Formulary alternatives available (venlafaxine ER tabs

37.5mg, 75mg, 150mg)

29

XALATAN

soln 0.005%

3

NF

Is not covered on our 2012 formulary as there are generic equivalents and/or generic alternatives available.

Generics available

(latanoprost)

30

XIBROM

soln 0.09%

3

NF

Is not covered on our formulary because it does not meet the definition of a Part D drug under CMS regulations and will not be considered for coverage determination

Formulary alternatives available (bromfenac)