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Provider Newsletter 2nd Quarter 2013 Medicare Part D Formulary Updates

August 16, 2013

A summary of recent Blue Cross and Blue Shield of Texas (BCBSTX) Medicare Part D formulary changes can be found below. The Blue MedicareRx 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 refer to the following instructions:

  1. Access the Prime Therapeutics' Medicare Part D member website 
  2. Click on Find Drugs & Estimates
  3. 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
  4. 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.
TRADE NAME
(generic name)
Brand/
Generic
Product
Effective DateDescription of ChangeComments
oxycodone
tabs, 10mg, 20mg
Generic 3/2/13 Addition Tier 2
Buprenorphine/naloxone
SL tabs, 2/0.5mg, 8/2mg
Generic 3/3/13 Addition Tier 1, Quantity limits apply — First generic for SUBOXONE
PROLASTIN
(alpha 1 proteinase inhibitor) for IV soln, 500mg, 1000mg
Brand 3/6/13 REMOVAL NDC not properly listed with the FDA
Zoledronic acid ing for IV infusion, 4mg/5ml Generic 3/10/13 Addition Tier 3 — First generic for ZOMETA
Risperidone orally disintegrating tabs, 0.25mg Generic 3/17/13 Cost Share Reduction Change to Tier 2 (was 4), prior authorization and quantity limits continue to apply
Betamethasone valerate oint, 0.1% Generic 3/20/13 Cost Share Reduction Change to Tier 1 (was 4)
Entacapone tabs, 200mg Generic 3/31/13 Addition Tier 2 — First generic for COMTAN
Acyclovir oint, 5% Generic 4/7/13 Addition Tier 2 — First generic for ZOVIRAX
Sodium phenylbutyrate oral powder Generic 4/14/13 Addition Tier 5 — First generic for BUPHENYL Powder
CREON (pancrelipase [lipase-protease-amylase]) DR caps, 36,000-114,000-180,000 units Generic 4/21/13 Addition Tier 3
Nystatin-triamcinolone crm, 100,000 units/gm 0.1% Generic 4/28/13 Cost Share Reduction Change to Tier 2 (was 4)
BRILANTA (ticagrelor) tabs, 90mg Brand 5/1/13 Addition Tier 3
AFINITOR DISPERZ (everolimus) tabs for oral susp, 2mg, 3mg, 5mg Brand 5/5/13 Addition Tier 5, prior authorization and quantity limits apply
Cephalexin caps, 750mg Generic 5/12/13 Addition Tier 1
Candesartan tabs, 4mg, 8mg, 16mg, 32mg Generic 5/26/13 Addition Tier 2, quantity limits apply — First generic for ATACAND
SUPRAX (cefixime) caps, 400mg Brand 6/3/13 Addition Tier 4
TAFINLAR (dabrafenib) caps, 50mg, 75mg Brand 6/3/13 Addition Tier 5, prior authorization and quantity limits apply
MEKINIST (tramentinib) tabs, 0.5mg, 2mg Brand 6/9/13 Addition Tier 5, prior authorization and quantity limits apply
REVLIMID (lenalidomide) caps, 20mg Brand 6/16/13 Addition Tier 5, prior authorization and quantity limits apply
Riluzole tabs, 50mg Generic 6/23/13 Addition Tier 5 — First generic for RILUTEK
ABILIFY MAINTENA
(aripiprazole) IM ing, 300mg, 400mg
Brand 6/26/13 Addition Tier 5, quantity limits apply