Blue Medicare Rx Medicare Part D Formulary Changes 2011 to 2012

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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.

#	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)