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Blue Medicare Rx Medicare Part D Formulary Changes 2012 to 2013

December 18, 2012

The 2013 Medicare Part D annual Open Enrollment Period (OEP) began October 15, 2012 and ended on December 7, 2012. On October 23, 2012 the 2013 Blue MedicareRx Blue Cross and Blue Shield of Texas (BCBSTX) Medicare Part D formulary was granted ‘conditional approval’ by the Centers for Medicare and Medicaid Services (CMS) and as with all Medicare Part D drug plans you can expect a number of formulary and utilization management changes for 2013. 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 2013 Part D formulary changes include addition of some new drug therapies as well as the migration to some important generic equivalents (e.g. BONIVA tablets, LIPITOR, MAXALT, and TRICOR) that have and/or will become available in 2013.

A copy of 2012 to 2013 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 were mailed in mid-November 2012, alerting them of 2013 formulary changes (removals, tier changes, new utilization management programs, etc.) affecting them. Finally, a copy of the 2013 formulary is already available on the BCBSTX provider website at bcbstx.com/provider 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 2013 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, 2012 with an effective date of January 1, 2013.

Affected Drug(s)

Description of Change

Formulary Alternative, if Applicable

amphetamine/dextroamphetamine tabs

Is not covered on our 2013 formulary

amphetamine/dextroamphetamine ER capsule or Adderall XR capsule

ANDROGEL

Is on our formulary and newly requires prior authorization before we will continue payment for this drug. Quantity limits may newly apply.

Check with your doctor

nevirapine

tab, 200 mg

Generic

5/27/12

ATRIPLA

Is on our formulary; however quantity limits may newly apply

On formulary, quantity limits may apply

AVONEX kit, AVONEX PEN

Is on our formulary and newly requires prior authorization before we will continue payment for this drug. Quantity limits may apply.

Check with your doctor

BONIVA tabs

Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.

ibandronate

BRILINTA

Is not covered on our 2013 formulary

clopidogrel or Effient

CARBATROL

Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.

carbamazepine SR

carbinoxamine liquid, tabs, Arbinoxa

Is not covered on our 2013 formulary

Check with your doctor

COPAXONE

Is on our formulary and newly requires prior authorization before we will continue payment for this drug. Quantity limits may apply.

Check with your doctor

cyproheptadine syrup, tabs

Is not covered on our 2013 formulary

levocetirizine tabs

DERMOTIC

Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.

fluocinolone acetonide (otic) oil 0.01%

diphenoxylate/atropine tabs, Lonox, Lofene

Is not covered on our 2013 formulary

loperamide capsule

FEMARA

Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.

letrozole

flunisolide nasal spray

Is not covered on our 2013 formulary

fluticasone, triamcinolone acetonide, or Nasonex nasal spray

guanfacine

tab, 200 mg

Generic

5/27/12

haloperidol concentrate, tabs

Is on our formulary and newly requires prior authorization before we will pay for this drug.

Check with your doctor

hydroxyzine pamoate caps

Is not covered on our 2013 formulary

levocetirizine tabs

ISENTRESS

Is on our formulary; however quantity limits may newly apply

On formulary, quantity limits may apply

LIPITOR

Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.

atorvastatin

LODOSYN

Is not covered on our 2013 formulary

carbidopa/levodopa, amantadine, Apokyn, bromocriptine, Comtan, pramipexole, ropinirole, or selegiline

MAXALT, MAXALT-MLT

Is not covered on our 2013 formulary

naratriptan or sumatriptan tablets

meprobamate

Is not covered on our 2013 formulary

buspirone

MESTINON TIMESPAN

Is not covered on our 2013 formulary

pyridostigmine regular release tablet

NORVIR caps, solution, tabs

Is on our formulary; however quantity limits may newly apply

On formulary, quantity limits may apply

olanzapine

Is on our formulary and newly requires prior authorization before we will pay for this drug. Quantity limits may apply.

Check with your doctor

ISENTRESS

Is on our formulary; however quantity limits may newly apply

On formulary, quantity limits may apply

PERPHENAZINE/AMITRIPTYLINE

Is not covered on our 2013 formulary

quetiapine, risperidone, ziprasidone

quetiapine

Is on our formulary and newly requires prior authorization before we will pay for this drug. Quantity limits may apply.

Check with your doctor

REVATIO tabs

Is not covered on our 2013 formulary

Adcirca, Letairis, or Tracleer

SEROQUEL

Is on our formulary and newly requires prior authorization before we will pay for this drug. Quantity limits may apply.

Check with your doctor

SUBOXONE

Is on our formulary; however quantity limits may newly apply

On formulary, quantity limits may apply

TESTIM

Is not covered on our 2013 formulary

Androderm, Androgel or Fortesta

testosterone cypionate

Is on our formulary and newly requires prior authorization before we will continue payment for this drug. Quantity limits may newly apply.

Check with your doctor

TRICOR

Is not covered on our 2013 formulary

fenofibrate, Lipofen, or TriLipix

TRUVADA

Is on our formulary; however quantity limits may newly apply

On formulary, quantity limits may apply

VALTURNA

Has been discontinued by the manufacturer

eprosartan, irbesartan, or losartan