April 2023
Pharmacy Program Quarterly Update, Part 2: Changes Effective Jan. 1, 2023
Pharmacy Program Quarterly Update, Part 2:
Changes Effective Jan. 1, 2023
Contents
Important Pharmacy Benefit Reminders
Review Drug List Updates (Coverage Additions/Coverage Tier Changes) – Effective Jan. 1, 2023
Drug List Coverage Additions – As of Jan. 1, 2023
Drug List Coverage – Administrative Action Additions
Drug List Updates (Coverage Tier Changes) – As of Jan. 1, 2023
Drug List Updates (Coverage Tier Changes) – Administrative Action Changes
Standard Utilization Management Program Package Changes
New Dosages of Statin Drug to be Covered Without Cost Sharing
Reminder of Split Fill Program Category Expansion
Important Pharmacy Benefit Reminders
Jan. 1, 2023, is the start of a new year and renewed or new health insurance benefits for most Blue Cross and Blue Shield of Oklahoma (BCBSOK) members. As you see your patients, please consider the following reminders.
- Members’ benefits may be based on a new drug list when their plans renew in 2023.
- Discuss your patient’s benefits during an office visit or confirm their benefits by calling the number on their ID cards.
- Review the prescription drug list before prescribing medications.
- If your patients need a coverage exception or prior authorization request in order to take a medicine that may be excluded from coverage or included in a utilization management program, please visit the Prior Authorization/Step Therapy Programs section of our provider website at bcbsok.com/provider for the form and more information.
Treatment decisions are always between you and your patients. Coverage is subject to the terms and limits of your patients’ benefit plans. Please advise them to review their benefit materials for details.
Please note: Revisions (drugs still covered but moved to a higher, out-of-pocket payment level) and/or exclusions (drugs no longer covered) were included in the January Quarterly Pharmacy Changes Part 1 article. Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes.
Review Drug List Updates
(Coverage Additions/Coverage Tier Changes) – Effective Jan. 1, 2023
DRUG LIST CHANGES
Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some additions (new to coverage) and/or some coverage tier changes (drugs moved to a lower out-of-pocket payment level) will be made to the BCBSOK drug lists.
Please note: Revisions (drugs still covered but moved to a higher, out-of-pocket payment level) and/or exclusions (drugs no longer covered) were included in the January Quarterly Pharmacy Changes Part 1 article. Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes.
Drug List Coverage Additions – As of Jan. 1, 2023
| Drug1 | Drug Class/Condition Used For |
| Basic, Multi-Tier Basic, Enhanced and Multi-Tier Enhanced Drug Lists | |
| CLOMID (clomiphene citrate tab 50 mg) | Ovulation Induction |
| CLOMIPHENE CITRATE (clomiphene citrate tab 50 mg) | Ovulation Induction |
| SKYRIZI (risankizumab-rzaa subcutaneous soln cartridge 360 mg/2.4 ml) | Crohn's disease |
| TRIUMEQ PD (abacavir-dolutegravir-lamivudine tab for oral sus 60-5-30 mg) | HIV |
VEMLIDY (tenofovir alafenamide fumarate tab 25 mg) |
Hepatitis B |
| Multi-Tier Basic and Multi-Tier Enhanced Drug Lists | |
| aspirin chew tab 81 mg | Circulation |
| aspirin tab delayed release 81 mg | Circulation |
| bisoprolol fumarate tab 5 mg | Hypertension |
| chlorthalidone tab 50 mg | Hypertension, Edema |
| cyclopentolate hcl ophth soln 0.5% | Mydriasis Induction, Cycloplegic Refraction |
| dexmethylphenidate hcl tab 5 mg | Attention-Deficit Hyperactivity Disorder (ADHD) |
| doxycycline monohydrate tab 100 mg | Acne, Infections |
| esomeprazole magnesium cap delayed release 40 mg (base equivalent) | GERD, H. Pylori, Hypersecretory conditions, NSAID-associated Gastric Ulcer Prophylaxis |
| ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg | Contraception |
| ezetimibe tab 10 mg | Hypercholesterolemia |
| fenofibrate micronized cap 134 mg | Hypertriglyceridemia |
| ferrous sulfate soln 75 mg/ml (15 mg/ml elemental fe) | Iron Deficiency |
| fluoxetine hcl tab 10 mg | Depression, Mood Disorders |
| glycopyrrolate tab 1 mg | Chronic Severe Drooling, Peptic Ulcer Disease |
| haloperidol lactate oral conc 2 mg/ml | Schizophrenia |
| medroxyprogesterone acetate im susp 150 mg/ml | Contraception |
| norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg | Contraception |
| olopatadine hcl ophth soln 0.1% (base equivalent) | Allergic Conjunctivitis |
| potassium chloride cap er 8 meq, 10 meq | Hypokalemia |
| prazosin hcl cap 1 mg | Hypertension |
| sodium fluoride rinse 0.2% | Dental Caries Prophylaxis |
| solifenacin succinate tab 5 mg | Overactive Bladder |
| sotalol hcl (afib/afl) tab 160 mg | Atrial Fibrillation, Atrial Flutter |
| tadalafil tab 10 mg, 20 mg | Erectile Dysfunction |
| tadalafil tab 2.5 mg, 5 mg | Erectile Dysfunction, Benign Prostatic Hyperplasia |
| valsartan tab 160 mg | Hypertension |
| Balanced, Performance and Performance Select Drug Lists | |
| CAMZYOS (mavacamten cap 2.5 mg, 5 mg, 10 mg, 15 mg) |
Obstructive Hypertrophic Cardiomyopathy (NYHA Class II-III) |
| CONDOMS (various male condoms) | Contraception |
| estradiol vaginal tab 10 mcg (generic for VAGIFEM) | Vulvovaginal Atrophy |
| IMBRUVICA (ibrutinib oral susp 70 mg/ml) | Cancer |
| OLUMIANT (baricitinib tab 1 mg, 2 mg) | Rheumatoid arthritis/Covid-19 Treatment/Alopecia Areata |
| OLUMIANT (baricitinib tab 4 mg) | Covid-19 Treatment/Alopecia Areata |
| ORKAMBI (lumacaftor-ivacaftor granules packet 75-94 mg) | Cystic Fibrosis |
| RADICAVA ORS (edaravone oral susp 105 mg/5 ml) | ALS |
| RADICAVA ORS STARTER KIT (edaravone oral susp 105 mg/5ml) | ALS |
| ZTALMY (ganaxolone susp 50 mg/ml) | CDKL5 deficiency disorder-associated seizures |
| Performance and Performance Select Drug Lists | |
| gentamicin sulfate oint 0.1% | Bacterial Infections- Topical |
| Balanced Drug List | |
| ADLARITY (donepezil hydrochloride td patch weekly 5 mg/day, 10 mg/day) |
Alzheimer’s Disease |
| ASPRUZYO SPRINKLE (ranolazine er granules packet 500 mg, 1000 mg) |
Angina |
| bexarotene gel 1% | Cancer |
| CORDRAN (flurandrenolide oint 0.05%) | Inflammatory Conditions-Topical |
| cyclobenzaprine hcl tab 7.5 mg | Muscle Spasms |
| DICLOFENAC (diclofenac cap 35 mg) | Pain/Inflammation |
| DICLOFENAC EPOLAMINE (diclofenac epolamine patch 1.3%) | Pain/Inflammation |
| doxycycline hyclate tab 50 mg | Acne, Infections |
| FLECTOR (diclofenac epolamine patch 1.3%) | Pain/Inflammation |
| FLUOROPLEX (fluorouracil cream 1%) | Actinic Keratosis, Cancer |
| FLUOROURACIL (fluorouracil cream 0.5%) | Actinic Keratosis, Cancer |
| GLOPERBA (colchicine oral soln 0.6 mg/5 ml) | Gout |
| INDOMETHACIN (indomethacin cap 20 mg) | Pain/Inflammation |
| LICART (diclofenac epolamine patch 24hr 1.3%) | Pain/Inflammation |
| LYVISPAH (baclofen granules packet 5 mg, 10 mg, 20 mg) |
Muscle Spasms |
| meloxicam cap 5 mg, 10 mg | Pain/Inflammation |
| naproxen-esomeprazole magnesium tab dr 375-20 mg, 500-20 mg |
Pain/Inflammation |
| NARDIL (phenelzine sulfate tab 15 mg) | Depression |
| NORLIQVA (amlodipine besylate oral soln 1 mg/ml (base equivalent)) |
Hypertension, CAD |
| PANRETIN (alitretinoin gel 0.1%) | Cancer |
| RELAFEN DS (nabumetone tab 1000 mg) | Pain/Inflammation |
| ROXYBOND (oxycodone hcl tab abuse deter 5 mg, 15 mg, 30 mg) |
Pain |
| TIVORBEX (indomethacin cap 20 mg) | Pain/Inflammation |
| TLANDO (testosterone undecanoate cap 112.5 mg) | Hypogonadism |
| VERKAZIA (cyclosporine (ophth) emulsion 0.1%) | Vernal Keratoconjunctivitis |
| ZORVOLEX (diclofenac cap 18 mg, 35 mg) | Pain/Inflammation |
1Third-party brand names are the property of their respective owner.
Drug List Coverage – Administrative Action Additions
| Drug1 | Drug Class/Condition Used For | Effective Date |
| Balanced, Performance and Performance Select Drug Lists | ||
| ON/GO ONE COVID-19 ANTIGEN HOME TEST (covid-19 at home antigen test kit) |
Covid-19 Test | May 29, 2022 |
| SPIKEVAX COVID-19 VACCINE (covid-19 (sars-cov-2) mrna vacc-moderna im susp 100 mcg/0.5 ml) | Covid-19 Vaccine | May 29, 2022 |
| sorafenib tosylate tab 200 mg (base equivalent) | Cancer | June 5, 2022 |
| vilazodone hcl tab 10 mg, 20 mg, 40 mg | Depression | June 5, 2022 |
| MODERNA COVID-19 VACCINE 6-11Y (covid-19 mrna vaccine 6-11y-moderna im susp 50 mcg/0.5 ml) | Covid-19 Vaccine | June 17, 2022 |
| MODERNA COVID-19 VACCINE 6 MO-5Y (covid-19 mrna vaccine 6mo-5y-moderna im susp 25 mcg/0.25 ml) | Covid-19 Vaccine | June 17, 2022 |
| PFIZER-BIONTECH COVID-19 VACCINE/6 MO-4Y (covid-19 mrna vac tris-s 6mo-4y-pfizer im susp 3 mcg/0.2 ml) | Covid-19 Vaccine | June 17, 2022 |
| PREHEVBRIO (hepatitis b vaccine 3-antigen (recombinant) susp 10 mcg/ml) | Hepatitis B Vaccine | June 30, 2022 |
| dabigatran etexilate mesylate cap 75 mg (etexilate base equivalent) | Thromboembolism/stroke prophylaxis, DVT/PE Treatment, DVT/PE Prophylaxis | July 3, 2022 |
| FLUARIX QUADRIVALENT 2022–2023 (influenza virus vac split quadrivalent susp pref syr 0.5 ml) | Influenza Vaccine | July 10, 2022 |
| NOVAVAX COVID-19 VACCINE (covid-19 subunit prot recom adjuv vac-novavax im 5 mcg/0.5 ml) | Covid-19 Vaccine | July 14, 2022 |
| AFLURIA QUADRIVALENT 2022–2023 (influenza virus vac split quadrivalent susp pref syr 0.5 ml) | Influenza Vaccine | July 17, 2022 |
| AFLURIA QUADRIVALENT 2022–2023 (influenza virus vaccine split quadrivalent im inj) | Influenza Vaccine | July 17, 2022 |
| FLUAD QUADRIVALENT 2022–2023 (influenza vac type a&b surface ant adj quad pref syr 0.5 ml) | Influenza Vaccine | July 17, 2022 |
| FLUBLOK QUADRIVALENT 2022–2023 (influenza vac recomb ha quad pf soln pref syr 0.5 ml) | Influenza Vaccine | July 17, 2022 |
| FLUCELVAX QUADRIVALENT 2022–2023 (influenza vac tiss-cult subunt quad susp pref syr 0.5 ml) | Influenza Vaccine | July 17, 2022 |
| FLUCELVAX QUADRIVALENT 2022–2023 (influenza vac tissue-cultured subunit quadrivalent im susp) | Influenza Vaccine | July 17, 2022 |
| FLUZONE HIGH-DOSE PF 2022–2023 (influenza vac split high-dose quad pf susp pref syr 0.7 ml) | Influenza Vaccine | July 17, 2022 |
| FLUZONE QUADRIVALENT 2022–2023 (influenza virus vac split quadrivalent susp pref syr 0.5 ml) | Influenza Vaccine | July 17, 2022 |
| FLUZONE QUADRIVALENT 2022–2023 (influenza virus vaccine split quadrivalent im inj) | Influenza Vaccine | July 17, 2022 |
| FLUZONE QUADRIVALENT 2022–2023 (influenza virus vaccine split quadrivalent inj 0.5 ml) | Influenza Vaccine | July 17, 2022 |
| PURE COMFORT INHALER SPAC ER CHAMBER ADULT (spacer/aerosol-holding chambers - device) | Asthma/Chronic Obstructive Pulmonary Disease |
August 14, 2022 |
| PILOT COVID-19 AT-HOME TEST (covid-19 at home antigen test kit) | Covid-19 Test | August 21, 2022 |
| GENABIO COVID-19 RAPID SELF TEST KIT 2-PACK (covid-19 at home antigen test kit) | Covid-19 Test | August 28, 2022 |
| MODERNA COVID-19 VACCINE/BIVALENT/BA.4/BA.5 (covid-19 mrna bivalent vaccine-moderna im susp 50 mcg/0.5 ml) | Covid-19 Vaccine | August 31, 2022 |
| PFIZER-BIONTECH COVID-19 VACCINE/BIVALENT/BA.4/BA.5 (covid-19 mrna bivalent vaccine-pfizer im susp 30 mcg/0.3 ml) | Covid-19 Vaccine | August 31, 2022 |
| TRIUMEQ PD (abacavir-dolutegravir-lamivudine tab for oral sus 60-5-30 mg) | HIV | September 1, 2022 |
| dabigatran etexilate mesylate cap 150 mg (etexilate base equivalent) (generic for PRADAXA) | Thromboembolism/Stroke Prophylaxis, DVT/PE Treatment, DVT/PE Prophylaxis | September 4, 2022 |
| lenalidomide caps 2.5 mg, 20 mg (generic for REVLIMID) | Cancer | September 11, 2022 |
| sod sulfate-pot sulf-mg sulf oral sol 17.5-3.13-1.6 gm/177 ml (generic for SUPREP) | Bowel Prep | September 11, 2022 |
| CLINITEST RAPID COVID-19 ANTIGEN SELF-TEST (covid-19 at home antigen test kit) | Covid-19 Test | October 2, 2022 |
| estradiol td gel 0.25 mg/0.25 gm (0.1%), 0.75 mg/0.75 gm (0.1%), 0.5 mg/0.5 gm (0.1%), 0.75 mg/0.75 gm (0.1%), 1 mg/gm (0.1%), 1.25 mg/1.25 gm (0.1%) (generic for DIVIGEL) | Menopausal Vasomotor Symptoms | October 9, 2022 |
| tazarotene gel 0.05%, 0.1% (generic for TAZORAC) | Plaque Psoriasis, Acne Vulgaris | October 9, 2022 |
| PFIZER-BIONTECH COVID-19 VACCINE/BIVALENT/5-11Y (covid-19 mrna bivalent vac 5-11y-pfizer im susp 10 mcg/0.2 ml) | Covid-19 Vaccine | October 12, 2022 |
| roflumilast tab 500 mcg (generic for DALIRESP) | Chronic Obstructive Pulmonary Disease | October 23, 2022 |
| FRAGMIN (dalteparin sodium inj 2500 unit/ml) | DVT Prevention, DVT/PE Extended Treatment (Cancer), Unstable Angina | November 6, 2022 |
| PRIORIX (measles-mumps-rubella virus vaccines for subcutaneous susp) | Measles-Mumps-Rubella Vaccine | November 18, 2022 |
| MENVEO (meningococcal (a, c, y and w-135) oligo conj vac im soln) | Meningococcal Vaccine | November 20, 2022 |
| CALQUENCE (acalabrutinib maleate tab 100 mg) | Cancer | December 1, 2022 |
| fingolimod hcl cap 0.5 mg (base equivalent) (generic for GILENYA) | Multiple Sclerosis | December 1, 2022 |
| PIRFENIDONE (pirfenidone tab 534 mg) | Idiopathic Pulmonary Fibrosis | December 1, 2022 |
| VIJOICE (alpelisib (pros) pak 250 mg daily dose (200 mg & 50 mg tabs)) |
PIK3CA-related overgrowth spectrum | December 1, 2022 |
| VIJOICE (alpelisib (pros) tab therapy pack 50 mg, 125 mg daily dose) |
PIK3CA-related overgrowth spectrum | December 1, 2022 |
| Balanced and Performance Select Drug Lists | ||
| methylphenidate hcl cap er 24hr 10 mg (la) | Attention Deficit Hyperactivity Disorder (ADHD) | December 1, 2022 |
| Balanced Drug List | ||
| timolol maleate preservative free ophth soln 0.25% (generic for TIMOPTIC OCUDOSE) | Elevated Intra-ocular Pressure | September 18, 2022 |
| CLONIDINE ER (clonidine hcl tab er 24hr 0.17 mg (base equivalent) (generic for NEXICLON XR) | Hypertension | September 25, 2022 |
| LEVOFLOXACIN (levofloxacin ophth soln 1.5%) | Bacterial Conjunctivitis | October 9, 2022 |
| METHOCARBAMOL (methocarbamol tab 1000 mg) | Muscle Spasms | October 9, 2022 |
| ALLOPURINOL (allopurinol tab 200 mg) | Gout | October 23, 2022 |
| butalbital-acetaminophen cap 50-300 mg | Tension Headache | November 6, 2022 |
| naproxen sodium tab er 24hr 750 mg (base equivalent) (generic for NAPRELAN) | Pain/Inflammation | November 6, 2022 |
| penciclovir cream 1% (generic for DENAVIR) | Cold Sores | November 20, 2022 |
| Performance Select Drug List | ||
| diclofenac sodium soln 2% (generic for Pennsaid) | Osteoarthritis Pain, knee | November 20, 2022 |
1Third-party brand names are the property of their respective owner.
Drug List Updates (Coverage Tier Changes) – As of Jan. 1, 2023
| Drug1 | New Lower Tier | Drug Class/Condition Used For | |||||
| Balanced, Performance and Performance Select Drug Lists | |||||||
| bisoprolol fumarate tab 5 mg | Preferred Generic | Hypertension | |||||
| chlorthalidone tab 50 mg | Preferred Generic | Hypertension, Edema | |||||
| cyclopentolate hcl ophth soln 0.5% | Preferred Generic | Mydriasis Induction, Cycloplegic Refraction |
|||||
| dexmethylphenidate hcl tab 5 mg | Preferred Generic | Attention-Deficit Hyperactivity Disorder (ADHD) | |||||
| doxycycline monohydrate tab 100 mg | Preferred Generic | Acne, Infections | |||||
| ethynodiol diacetate & ethinyl estradiol tab 1 mg-35 mcg | Preferred Generic | Contraception | |||||
| ezetimibe tab 10 mg | Preferred Generic | Hypercholesterolemia | |||||
| fenofibrate micronized cap 134 mg | Preferred Generic | Hypertriglyceridemia | |||||
| glycopyrrolate tab 1 mg | Preferred Generic | Chronic Severe Drooling, Peptic Ulcer Disease |
|||||
| haloperidol lactate oral conc 2 mg/ml | Preferred Generic | Psychosis, Tourette Syndrome, Behavioral Disorders | |||||
| hydrocodone bitart-homatropine methylbrom soln 5-1.5 mg/5 ml | Preferred Generic | Cough | |||||
| medroxyprogesterone acetate im susp 150 mg/ml | Preferred Generic | Contraception | |||||
| norethindrone-eth estradiol tab 0.5-35/0.75-35/1-35 mg-mcg |
Preferred Generic | Contraception | |||||
| potassium chloride cap cr 8 meq, 10 meq |
Preferred Generic | Hypokalemia | |||||
| potassium chloride cap er 8 meq , 10 meq |
Preferred Generic | Hypokalemia | |||||
| prazosin hcl cap 1 mg | Preferred Generic | Hypertension | |||||
| sodium fluoride rinse 0.2% | Preferred Generic | Dental Caries Prophylaxis | |||||
| solifenacin succinate tab 5 mg | Preferred Generic | Overactive Bladder | |||||
| sotalol hcl (afib/afl) tab 160 mg | Preferred Generic | Atrial Fibrillation/Atrial Flutter | |||||
| tadalafil tab 2.5 mg, 5 mg | Preferred Generic | Erectile Dysfunction, Benign Prostatic Hyperplasia |
|||||
| tadalafil tab 10 mg* | Preferred Generic | Erectile Dysfunction | |||||
| tadalafil tab 20 mg* | Preferred Generic | Erectile Dysfunction, Pulmonary Arterial Hypertension | |||||
| valsartan tab 160 mg | Preferred Generic | Hypertension | |||||
| VEMLIDY (tenofovir alafenamide fumarate tab 25 mg) | Preferred Brand | Hepatitis B | |||||
| Balanced Drug List | |||||||
| Drug1 | New Lower Tier | Drug Class/Condition Used For | |||||
| fenoprofen calcium cap 400 mg | Non-Preferred Generics | Pain/Inflammation | |||||
| flunisolide nasal soln 25 mcg/act (0.025%) | Non-Preferred Generics | Allergic Rhinitis | |||||
| orphenadrine w/ aspirin & caffeine tab 25-385-30 mg | Non-Preferred Generics | Pain | |||||
| tramadol hcl tab 100 mg | Non-Preferred Generics | Pain | |||||
1Third-party brand names are the property of their respective owner.
*Optional sexual dysfunction component coverage for select health plans.
Drug List Updates (Coverage Tier Changes) – Administrative Action Changes
| Drug1 | New Lower Tier | Drug Class/Condition Used For | Effective Date | ||||
| Balanced, Performance and Performance Select Drug Lists | |||||||
| metoprolol & hydrochlorothiazide tab 100-50 mg |
Non-Preferred Generic | Hypertension | July 24, 2022 | ||||
| theophylline tab er 12hr 450 mg |
Non-Preferred Generic | Asthma/Chronic Obstructive Pulmonary Disease | July 3, 2022 | ||||
| theophylline tab er 12hr 300 mg |
Non-Preferred Generic | Asthma/Chronic Obstructive Pulmonary Disease | July 17, 2022 | ||||
| theophylline elixir 80 mg/15 ml | Non-Preferred Generic | Asthma/Chronic Obstructive Pulmonary Disease | October 2, 2022 | ||||
| benazepril & hydrochlorothiazide tab 5-6.25 mg | Non-Preferred Generic | Hypertension | October 23, 2022 | ||||
| Balanced and Performance Select Drug | |||||||
| dexamethasone tab 2 mg | Non-Preferred Generic | Inflammatory Conditions | September 18, 2022 | ||||
| VASCEPA (icosapent ethyl cap 0.5 gm) | Non-Preferred Generic | Severe Hypertriglyceridemia | September 30, 2022 | ||||
| chloroquine phosphate tab 500 mg | Non-Preferred Generic | Malaria | November 20, 2022 | ||||
| Performance Drug List | |||||||
| chloroquine phosphate tab 500 mg | Non-Preferred Generic | Malaria | October 23, 2022 | ||||
| dexamethasone tab 2 mg | Non-Preferred Generic | Inflammatory Conditions | October 23, 2022 | ||||
| ELIGARD (leuprolide acetate for subcutaneous inj kit 7.5 mg) | Preferred Brand | Cancer | October 23, 2022 | ||||
| ELIGARD (leuprolide acetate (3 month) for subcutaneous inj kit 22.5 mg) | Preferred Brand | Cancer | October 23, 2022 | ||||
| ELIGARD (leuprolide acetate (4 month) for subcutaneous inj kit 30 mg) | Preferred Brand | Cancer | October 23, 2022 | ||||
| ELIGARD (leuprolide acetate (6 month) for subcutaneous inj kit 45 mg) | Preferred Brand | Cancer | October 23, 2022 | ||||
| methylphenidate hcl cap er 24hr 10 mg (la) | Non-Preferred Generic | Attention Deficit Hyperactivity Disorder (ADHD) | October 23, 2022 | ||||
| VASCEPA (icosapent ethyl cap 0.5 gm) | Non-Preferred Generic | Severe Hypertriglyceridemia | October 23, 2022 | ||||
1Third-party brand names are the property of their respective owner.
Standard Utilization Management Program Package Changes
Retired Prior Authorization (PA) Program
Effective Dec. 1, 2022, the Reganex PA and the Nocturia PAQL programs were retired.
Prior Authorization (PA) Program Changes
Effective April 1, 2023, drug target nizatidine is being removed from the Alternative Dosage Form PAQL program. Additionally, Riomet IR oral solution is being moved from the Alternative Dosage Form PAQL program to the Metformin PAQL program.
For the most up-to-date drug list and list of drug dispensing limits, visit the Pharmacy Program section of our Provider website.
If your patients have any questions about their pharmacy benefits, please advise them to contact the number on their member ID card. Members may also visit bcbsok.com and log in to Blue Access for MembersSM (BAMSM) or MyPrime.com for a variety of online resources.
New Dosages of Statin Drug to be Covered Without Cost Sharing
The United States Preventive Services Task Force (USPSTF) updated its guidance around statin coverage for the prevention of cardiovascular disease. Previously the guidance recommended low-to-moderate doses of statin for preventive use, but the new guidance doesn’t specify dosage strength.
To align with the updated recommendation, two new dosage strengths of atorvastatin will be added to the list of statins covered at the preventive level on the Affordable Care Act (ACA) $0 Preventive Drug List, without member cost sharing.
- 40 mg atorvastatin
- 80 mg atorvastatin
This change will go into effect April 1, 2023, for all non-grandfathered ACA-compliant plans, regardless of renewal date.
Reminder of Split Fill Program Category Expansion
As of Jan. 1, 2023, the Split Fill Program has been expanded to include additional categories beyond oral oncology medications, such as multiple sclerosis and iron toxicity. A Split Fill program drug list is posted on the member pharmacy programs section of bcbsok.com.
BCBSOK offers its members and groups a Split Fill Program to reduce waste and help avoid costs of select medications that may go unused. Members new to therapy (or have not had claims history within the past 120 days for the drug) are provided partial, or “split,” prescription fills for up to three months.
The Split Fill Program applies to a specific list of drugs known to have early discontinuation or dose modification. You can view the current list of drugs and find more information on the Split Fill Program on our Provider website.
Please call the number on the member’s ID card to verify coverage, or for further assistance or clarification on your patient’s benefits.
BCBSOK contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. BCBSOK, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.com is an online resource offered by Prime Therapeutics.
Prime Therapeutics LLC is a pharmacy benefit management company. BCBSOK contracts with Prime to provide pharmacy benefit management and related other services. BCBSOK, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. MyPrime.com is an online resource offered by Prime Therapeutics.
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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. |