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Medicare Part D Formulary Updates 2nd Quarter 2012

July 26, 2012

A summary of recent Blue Cross and Blue Shield of Texas (BCBSTX) Medicare Part D formulary changes can be found below. The BlueMedicareRx formulary is updated monthly by our pharmacy provider, Prime Therapeutics. For a complete formulary listing and for future inquiries regarding prior authorizations, step therapy, coverage determinations/RE-determinations, transition plan benefits, and appointment of representative for your BCBSTX members please follow the following instructions: 

Utilize https://www.myprime.com to access the Prime Therapeutics’ Medicare Part D member website:

a) Click on ‘Find Drugs & Estimates’,

b) Follow directions to

  • ‘Select your Health Plan’ click on ‘BCBS Texas’,
  • ‘Medicare Part D Member?’ Click ‘YES’,
  • ‘Select Your Health plan type’  Click ‘Blue MedicareRx’

c) From this page you will be able to determine the formulary status and applicable utilization management programs for individual drugs or access any of the important databases outlined above.  

 

Generic name

(TRADE NAME)

BRAND Generic Product

Effective Date

Description of Change

Comments

doxorubicin liposomal inj, 2 mg/mL

Generic

2/26/12

Addition

Tier 1. May be covered by Medicare Part B or Medicare Part D depending on circumstances.

AFINITOR (everolimus) tab, 7.5 mg

Brand

3/4/12

Addition

Tier 4. Prior authorization and quantity limits apply.

ziprasidone
cap, 20 mg, 40 mg, 60 mg, 80 mg

Generic

3/4/12

Addition

Tier 1. Quantity limits apply. Generic for GEODON.

ZYCLARA (imiquimod) pump cream, 3.75%

Brand

3/4/12

Addition

Tier 2. Prior authorization and quantity limits apply.

methotrexate for inj

Generic

3/25/12

Cost Share Reduction

Change to Tier 1 (was 3).

MENEST tab, 0.3 mg, 0.625 mg, 1.25 mg, 2.5 mg

Brand

3/30/12

Addition

Tier 3.

quetiapine tab, 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg

Generic

4/1/12

Addition

Tier 1. Quantity limits apply. First generic for Seroquel.

escitalopram oral soln, 5 mg/5 mL; tab, 5 mg, 10 mg, 20 mg

Generic

4/1/12

Addition

Tier 1. Quantity limits apply. First generic for Lexapro.

irbesartan tab, 75 mg, 150 mg, 300 mg

Generic

4/8/12

Addition

Tier 1. Quantity limits apply. First generic for Avapro.

irbesartan/ hydrochlorothiazide tab, 150-12.5 mg, 300-12.5 mg

Generic

4/8/12

Addition

Tier 1. Quantity limits apply. First generic for Avalide.

morphine sulfate oral soln, 10 mg/5 mL, 20 mg/5 mL

Generic

4/10/12

Cost Share Reduction

Change to Tier 1 (was 3).

REVLIMID (lenalidomide) cap, 2.5 mg

Brand

4/22/12

Addition

Tier 4. Quantity limits apply.

dextroamphetamine tab, 10 mg

Generic

4/22/12

Cost Share Reduction

Change to Tier 1 (was 3). Quantity Limits continue to apply.

ibandronate sodium tab, 150 mg

Generic

4/22/12

Addition

Tier 1. Quantity limits apply. May be covered by Medicare Part B or Medicare Part D depending on circumstances. First generic for Boniva.

vancomycin cap, 125 mg, 250 mg

Generic

4/29/12

Addition

Tier 4. First generic for Vancocin..

VIIBRYD (vilazodone) tab, starter kit containing 10 mg, 20 mg, and 40 mg

Brand

4/29/12

Addition

Tier 2. Step therapy and quantity limits apply.

JANUMET XR (sitagliptin-metformin) extended-release tab, 50-500 mg, 50-1000 mg, 100-1000 mg

Brand

5/1/12

Addition

Tier 2. Step therapy and quantity limits apply.

JENTADUETO (linagliptin-metformin) tab, 2.5-500 mg, 2.5-850 mg, 2.5-1000 mg

Brand

5/1/12

Addition

Tier 3. Step therapy and quantity limits apply.

KALYDECO (ivacaftor) tab, 150 mg

Brand

5/1/12

Addition

Tier 4. Prior authorization and quantity limits apply.

PROLIA (denosumab) inj, 60 mg/mL

Brand

5/1/12

Addition

Tier 4. Prior authorization applies.

TRADJENTA (linagliptin) tab, 5 mg

Brand

5/1/12

Addition

Tier 3. Step therapy and quantity limits apply.

INTELENCE (etravirine) tab, 25 mg

Brand

5/6/12

Addition

Tier 3.

clopidogrel tab, 75 mg

Generic

5/20/12

Addition

Tier 1. First generic for Plavix.