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Medicare Part D Formulary Updates

November 14, 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

nevirapine

tab, 200 mg

Generic

5/27/12

Addition

Tier 1. First generic for VIRAMUNE.

 

PROLIA (denosumab)
inj, 60 mg/mL

Brand

6/1/12

Cost Share Reduction

Change to Tier 3 (was 4). Prior Authorization continues to apply.

 

voriconazole
inj, 200 mg

Generic

6/3/12

Addition

Tier 1. First generic for VFEND IV. Prior authorization applies.

cytarabine
inj, 20 mg/mL

Generic

6/3/12

Cost Share Reduction

Change to Tier 1 (was 3). May be covered by Medicare Part B or Medicare Part D depending on circum-stances.

 

PERJETA (pertuzumab)
soln for inj,
420 mg/14 mL

Generic

6/17/12

Addition

Tier 4

POTIGA (ezogabine) tabs, 50 mg,
200 mg, 300 mg, 400 mg

Brand

7/1/12

Addition

Tier 3. Step Therapy applies.

abacavir
tabs, 300 mg

Generic

7/1/12

Addition

Tier 1.

hydrochlorothiazide tabs, 12.5 mg

Generic

7/8/12

Cost Share Reduction

Change to Tier 1 (was 3).

alfuzosin ER
tabs, 10 mg

Generic

8/1/12

Addition

Tier 1. Quantity limits apply.

PICATO (ingenol mebutate)
gel, 0.015%, 0.05%

Brand

8/1/12

Addition

Tier 2.

PREVACID SOLUTAB (lansoprazole) delayed-release orally disintegrating

tabs, 15 mg, 30 mg

Brand

8/1/12

Addition

Tier 3. Quantity limits apply.

calcipotriene

cream, 0.005%

Generic

8/5/12

Addition

Tier 1. First generic for DOVONEX cream.

DIPHTHERIA/TETANUS TOXOIDS ADSORBED PEDIATRIC

IM inj,

25-5 units/0.5 mL

Brand

8/5/12

Addition

Tier 3.

montelukast

chew tabs, 4 mg,

5 mg; tabs, 10 mg

Generic

8/5/12

Addition

Tier 1. First generic for SINGULAIR.

LYRICA (pregabalin) oral soln, 20 mg/mL

Brand

8/12/12

Addition

Tier 2.

pioglitazone

tabs, 15 mg,

30 mg, 45 mg

Generic

8/19/12

Addition

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

ZALTRAP
(ziv-aflibercept)

IV soln, 100 mg/4 mL, 200 mg/8 mL

Brand

8/19/12

Addition

Tier 4.

ZYCLARA (imiquimod) pump cream, 2.5%

Brand

8/19/12

Addition

Tier 2. Prior authorization and quantity limits apply

modafinil

tabs, 100 mg, 200 mg

Generic

8/22/12

Addition

Tier 1. Prior authorization and quantity limits apply. First generic for PROVIGIL.