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Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2016

July 11, 2016

DRUG LIST (FORMULARY) CHANGES
Based on the availability of new prescription medications and the Prime's National Pharmacy and Therapeutics Committee's review of changes in the pharmaceuticals market, some revisions were made to the BCBSTX standard drug list and generics plus drug list effective July 1, 2016.

Brand Medications Added to the Standard and Generics Plus Drug Lists, Effective July 1, 2016

Preferred Brand1 Drug Class/Condition Used For
Adynovate Hemophilia
Brilinta DVT, Stroke and Embolism Prophylaxis
Coagadex Hemophilia
Depen Wilson's Disease, Cystinuria
Narcan Opiate Overdose
Uptravi Pulmonary Arterial Hypertension

Brand Medications Added to the Generics Plus Drug List, Effective July 1, 2016

Preferred Brand1

Drug Class/Condition Used For

Eliquis

DVT, Stroke and Embolism Prophylaxis

UTILIZATION MANAGEMENT PROGRAM CHANGES
Effective July 1, 2016, several drug categories and/or targeted medications were added to the current Prior Authorization (PA) and Step Therapy (ST) programs for BCBSTX select members on standard pharmacy benefit plans.

Drug categories added to the pharmacy PA standard programs, effective July 1, 2016

Drug Category Targeted Medication(s)1, 2

Ophthalmic Immunomodulators

Restasis

Targeted drugs added to current pharmacy PA standard programs, effective July 1, 2016

Drug Category

Targeted Medication(s)1, 2

Therapeutic Alternatives

Kadian, Northera, Onmel, Sporanox, Spritam, Zegerid, Zyflo/Zyflo CR

Drug Categories added to current pharmacy ST standard programs, effective July 1, 20163

Drug Category

Targeted Medication(s)1, 2

Atypical Antipsychotics

Abilify, Abilify Discmelt, Abilify Maintena, Aripiprazole ODT, Aristada, Clozaril, Fanapt, Fazaclo, Clozapine ODT, Geodon, Invega, Invega Sustenna, Invega Trinza, Latuda, Rexulti, Risperdal, Risperdal M-Tab, Risperdal Consta, Saphris, Seroquel, Seroquel XR, Versacloz, Zyprexa, Zyprexa Zydis, Zyprexa Relprevv

For the most up-to-date drug list and list of drug dispensing limits, visit the Pharmacy Program section of our website at bcbstx.com/provider

1Third party brand names are the property of their respective owners
2These lists are not all inclusive. Other medications may be available in this drug class.
3Members on a current drug regimen will be grandfathered from participation in the ST program.

Prime Therapeutics LLC is a pharmacy benefit management company. BCBSTX contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSTX, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.

The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member's certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.