February 2024
Contents
Pharmacy Benefit Reminders
Drug List Changes
Drug List Additions – Effective Jan. 1, 2024
Balanced Drug List Additions
Performance Drug List Additions
Performance Select Drug List Additions
Basic and Enhanced Drug List Additions
Basic Multi-Tier and Enhanced Multi-Tier Drug List Additions
Other Drug List Additions
Balanced Drug List Additions
Performance Drug List Additions
Performance Select Drug List Additions
Basic and Enhanced Additions, Basic Multi-Tier and Enhanced Multi-Tier Additions
Drug Tier Changes – Effective Jan. 1, 2024
Balanced Drug List Tier Changes
Performance Drug List Tier Changes
Performance Select Drug List Tier Changes
Other Drug List Tier Changes
Balanced Drug List Tier Changes
Performance Drug List Tier Changes
Performance Select Drug List Tier Changes
Utilization Management Program Changes
Dispensing Limit Changes
Balanced, Performance, and Performance Select Basic, Basic Multi-Tier, Basic Annual, Basic Multi-Tier Annual, Enhanced, Enhanced Annual, Enhanced Annual Multi-Tier Drug Lists Health Information Marketplace (HIM)
Standard Utilization Management Program Updates
Change in Benefit Coverage for Select High-Cost Products
Pharmacy Benefits Updates
BCBSOK Offers LifeScan as Preferred Option for Glucose Management
Appropriate Use of Opioids Program to be Retired January 2024
Reminder: BCBSOK’s Updated Approach to Managing GLP-1 Agonist Medications
Reminder: The Quarterly Pharmacy Changes awareness article is published in two parts. This article is a continuation of the previously published January Quarterly Pharmacy Changes Part 1 article, which included changes that require member notification — drug list revisions/exclusions, dispensing limits, utilization management changes and general information on pharmacy benefit program updates. This Part 2 article contains recent coverage additions, utilization management updates and any other pharmacy program updates.
Pharmacy Benefit Reminders
A new year often welcomes new members to Blue Cross and Blue Shield of Oklahoma or updates to benefits for our current members. Discussing your patient’s pharmacy benefits can help with this transition.
As you visit with your patients, also consider the following:
Your patient’s pharmacy benefits may be new to them or apply to an updated drug list. The drug lists are available on our member and provider websites to help both you and your patients when prescribing medication.
Review the prescription drug list before prescribing medications. Some drugs may have been excluded from coverage or have updated requirements applied to their utilization management program.
If your patients need a coverage exception or prior authorization request, visit the Prior Authorization/Step Therapy Programs site for both forms and more information.
Some members’ plans may experience changes to the pharmacy network, such as moving to a new pharmacy network or changes to pharmacies participating within the network. Those impacted members received letters alerting of them of these potential out-of-pocket changes.
In most cases, no action is required on your part for these pharmacy network changes. Members can easily transfer prescriptions to an in-network pharmacy. You may want to ask which pharmacy is their preferred choice if your office stores pharmacy information on patient records.
If you or your patients are concerned about a particular drug benefit change, call the number on their ID card to confirm any new or updated pharmacy benefits.
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.
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 Blue Cross and Blue Shield of Oklahoma (BCBSOK) drug lists. Additions effective January 1, 2024, and previous updates are outlined below.
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].
You can view the January drug lists on our member website.
Drug List Additions – Effective Jan. 1, 2024
Other Drug List Additions
Most additions to the drug list become effective quarterly, however, some drugs are added as part of formulary maintenance (e.g., new strength of covered drug) or re-evaluated during the quarter then added to the list.
Those drugs are listed below.
Drug Tier Changes – Effective Jan. 1, 2024
The tier changes listed below apply to members on a managed drug list.
Other Drug List Tier Changes
Most tier changes become effective quarterly, however, some drugs are moved to a new tier as part of formulary maintenance or re-evaluated during the quarter. Those drugs are listed below with their addition date.
Utilization Management Program Changes
Utilization Management programs are implemented to regularly review the appropriateness of medications within drug-therapy programs, and as a result, may adjust dispensing limits, prior authorization or step-therapy requirements. The following drug programs reflect those changes.
Dispensing Limit Changes
BCBSOK’s prescription drug benefit program includes coverage limits on certain medications and drug categories. Dispensing limits, or quantity limits (QLs), are based on U.S. Food and Drug Administration (FDA) approved dosage regimens and product labeling. New dispensing limits and effective dates are listed on the chart below.
Standard Utilization Management Program Updates
The prior authorization (PA) programs for standard pharmacy benefit plans correlate to a member's drug list. Not all standard PA programs may apply, based on the member's current drug list. A list of PA programs per drug list is posted on the member pharmacy programs section of bcbsok.com. View the most up-to-date drug list and list of drug dispensing limits on bcbsok.com. 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.
Program Removals
The following standard utilization management programs were updated to remove target drugs on the dates indicated below.
Alternative Dosage Form PAQL: removed Digoxin oral soln 0.05 mg/mL and spironolactone susp 25 mg/mL from this program effective Jan. 1, 2024.
Oral Tetracycline Derivatives PA: removed Doxycycline Monohydrate 150 mg tab from this program effective Dec. 15, 2023.
Supplemental Therapeutic Alternatives removed Auvi-Q and Winlevi from this program effective Jan. 1, 2024. Winlevi has moved to the Winlevi PA, effective Jan. 1, 2024.
Therapeutic Alternatives PAQL: removed Cardizem CD, Dexamethasone therapy Pak, Prolate and Vanos, effective Jan. 1, 2024.
Program Retirements
The following standard utilization management programs have been retired on the dates indicated below.
Amantadine ER PAQL program was retired Nov. 15, 2023.
This program included the following drugs: Gocovri (Amantadine HCL) ER cap 24 hr 68.5 mg, 137 mg (base), Osmolex ER (Amantadine HCL) 24 hr 129 mg tab, 193 mg tab, 258 mg tab, and Osmolex ER (Amantadine HCL) 24 hr Pak 129 mg & 193 mg (322 mg dose)
Amylin Analogues QL program was retired Nov. 15, 2023.
This program included the following drugs: Symlinpen (pramlintide acetate) 120 and Symlinpen (pramlintide acetate) 60.
Natpara PAQL was retired effective Nov. 15, 2023.
This program included the following drugs: Natpara parathyroid hormone (recombinant) for Inj cartridge 25 mcg, 50 mcg, 75 mcg, 100 mcg.
Nuvigil, Provigil PAQL was retired effective Nov. 15, 2023.
This program included the following drugs: NUVIGIL (armodafinil) tab 50 mg, 150 mg, 200 mg, 250 mg and PROVIGIL (modafinil) tab 100 mg.
Rho Kinase Inhibitors STQL was retired effective Nov. 15, 2023.
This program included the following drugs Rhopressa (Netarsudil dimesylate) opth soln 0.02% and Rocklatan (Netasurdil dimesylate-latanoprost) opthl soln 0.02-0.005%.
Change in Benefit Coverage for Select High-Cost Products
Several high-cost products with available lower cost alternatives will be excluded on the pharmacy benefit for select drug lists. This change impacts BCBSOK members who have prescription-drug benefits administered by Prime Therapeutics†. This change is part of an ongoing effort to make sure our members and employer groups have access to safe, cost-effective medications.
Please note: Members were not notified of this change because either there is no utilization, or the pharmacist can easily fill a member's prescription with the equivalent without needing a new prescription from the doctor. The following drugs are excluded on select drug lists.
Pharmacy Benefits Updates
BCBSOK Offers LifeScan as Preferred Option for Glucose Management
New for Members with Diabetes: The LifeScan® One Touch test strips and supplies have been added as preferred options for BCBSOK members with diabetes effective Jan. 1, 2024. LifeScan products include the OneTouch family of meters, such as the OneTouch Verio Reflect®, Verio Flex®, Ultra Plus Flex™, and Ultra 2® test strips and supplies.
All preferred diabetic glucose-monitoring devices and supplies are available to members with Prime Therapeutics as their pharmacy benefit manager. Members can use a coupon to receive a free OneTouch meter.
Contour and Contour Next test strips remain preferred options for managing diabetes. Members can use a coupon to obtain the Contour Next Gen and Contour Next EZ meters at no cost, as well.
LifeScan’s OneTouch test strips have been removed from the Glucose Test Strip STQL effective Jan. 1, 2024.
Note: The member flier contains a coupon for members to obtain a free blood glucose monitor.
Appropriate Use of Opioids Program to be Retired January 2024
What’s new: The Appropriate Use of Opioids program will be retired effective January 1, 2024. However, BCBSOK will continue to promote safe and effective use of prescription opioids through an approach that more closely aligns with the Center for Disease Control’s 2022 Guidelines for Prescribing Opioids for Pain, which emphasize flexibility and individualized care.
New Approach: BCBSOK’s new approach will eliminate hard edits – or benefit rejections at the pharmacy counter – and instead be updated to soft edits, which will allow the pharmacy or provider to determine whether to dispense.
The soft edits are in place to alert the pharmacy if: an opioid naïve member has an opioid prescription that exceeds seven days; or, if a member has exceeded dosage limits and has filled overlapping opioid prescriptions at two or more pharmacies and from two or more providers.
A member is considered opioid naïve if they have not filled an opioid prescription within the past 60 days, based on pharmacy claims data. Examples of medications targeted by these new standards are opioid agonists like codeine, oxycodone, hydromorphone, morphine, and opioid combination products like oxycodone/acetaminophen and hydrocodone/acetaminophen.
Also new on Jan. 1, 2024, is the Opioids Extended Release Prior Authorization Quantity Limits program with Oxycontin as the lone target. Other opioid quantity limits which existed under AUO will continue under the new Opioids ER PAQL.
Reminder: BCBSOK’s Updated Approach to Managing GLP-1 Agonist Medications
Blue Cross and Blue Shield of Oklahoma is committed to providing its members access to safe, appropriate, and cost-effective health care within their plan benefits. To ensure the appropriate use of GLP-1s as indicated for diabetes, we are making it easier for providers to bypass our prior authorization (PA) process for some of our members with diabetes. For more information, review the full article on bcbsok.com.
