March 2024
Pharmacy Program Quarterly Update Changes Effective April 1, 2024 – Part 1
Contents
Drug List Changes
Drug List Exclusions/Revisions – Effective April 1, 2024
Balanced Drug List Exclusions
Performance Drug List Exclusions
Performance Select Drug List Exclusions
Health Insurance Marketplace Drug List Exclusions
Basic, Enhanced, Multi-Tier Basic and Multi-Tier Enhanced Revisions
Drug Tier Changes – As of April 1, 2024
Balanced Drug List Tier Changes
Performance Drug List Tier Changes
Performance Select Drug List Tier Changes
Health Insurance Marketplace Exchange Drug List Tier Changes
Utilization Management Program Changes
Additions to Standard Prior Authorization Program – Effective April 1, 2024
Basic, Multi-Tier Basic, Enhanced, Multi-Tier Enhanced Drug Lists, and Health Insurance Marketplace
Balanced, Performance, Performance Select, Basic, Multi-Tier Basic, Enhanced, Multi-Tier Enhanced and Health Insurance Marketplace Drug Lists
Dispensing Limit Changes
Balanced, Performance, Performance Select, Basic, Multi-Tier Basic, Enhanced, Multi-Tier Enhanced and Health Insurance Marketplace Drug Lists
Change in Benefit Coverage for Select High-Cost Products
Pharmacy Benefits Updates
Reminder: BCBSOK Offers LifeScan as Preferred Option for Glucose Management
Reminder: BCBSOK’s Updated Approach to Managing GLP-1 Agonist Medications
Reminder: The Quarterly Pharmacy Changes awareness article is published in two parts. This part 1 article includes changes that require member notification – drug list revisions/exclusions, dispensing limits, utilization management changes and general information on pharmacy benefit program updates. Our intention is to alert you of these changes as our members are receiving letters on changes to their drug list and/or pharmacy benefit. The part 2 article will be published closer to the April 1, 2024, effective date.
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 revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) will be made to the Blue Cross and Blue Shield of Oklahoma drug lists, effective on or after April 1, 2024.
The April Quarterly Pharmacy Changes Part 2 article with recent coverage additions will be published closer to the April 1 effective date.
Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes.
Drug-list changes are listed on the charts below or you can view current drug lists on our member website.
Drug List Exclusions/Revisions – Effective April 1, 2024
|
Balanced Drug List Exclusions |
Drug1 |
Alternatives1, 2 |
Drug Class/Condition |
CAROSPIR (spironolactone susp 25 mg/5 ml) |
eplerenone tablet, spironolactone tablet, triamterene capsule |
Heart Failure, Hypertension, Edema |
DIASTAT ACUDIAL (diazepam rectal gel delivery system 10 mg, 20 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Acute Repetitive Seizures |
LIVALO (pitavastatin calcium tab 1 mg, 2 mg, 4 mg) |
atorvastatin, lovastatin, rosuvastatin, pravastatin, simvastatin |
Hyperlipidemia, Hypercholesterolemia |
MITIGARE (colchicine cap 0.6 mg) |
colchicine tablet 0.6 mg |
Gout |
NORDITROPIN FLEXPRO (somatropin solution pen-injector 5 mg/1.5 ml, 10 mg/1.5 ml, 15 mg/1.5 ml, 30 mg/3 ml) |
GENOTROPIN, OMNITROPE |
Growth Hormone Deficiency, Short Stature, Growth Failure |
ONEXTON (clindamycin phosphate-benzoyl peroxide gel 1.2%-3.75%) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Acne |
OXANDROLONE (oxandrolone tab 2.5 mg, 10 mg) |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Promotes Weight Gain |
oxandrolone tab 2.5 mg, 10 mg |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Promotes Weight Gain |
VOTRIENT (pazopanib hcl tab 200 mg (base equiv)) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Cancer |
VYVANSE (lisdexamfetamine dimesylate cap 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
VYVANSE (lisdexamfetamine dimesylate chew tab 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
| Performance Drug List Exclusions |
Drug1 |
Alternatives1, 2 |
Drug Class/Condition |
CROTAN (crotamiton lotion 10%) |
permethrin |
Scabies |
DIASTAT ACUDIAL (diazepam rectal gel delivery system 10 mg, 20 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Acute Repetitive Seizures |
FLURAZEPAM HYDROCHLORIDE (flurazepam hcl cap 15 mg, 30 mg) |
estazolam, temazepam |
Insomnia |
INSULIN ASPART (insulin aspart inj soln 100 unit/ml) |
NOVOLOG |
Diabetes |
INSULIN ASPART FLEXPEN (insulin aspart soln pen-injector 100 unit/ml) |
NOVOLOG |
Diabetes |
INSULIN ASPART PENFILL (insulin aspart soln cartridge 100 unit/ml) |
NOVOLOG |
Diabetes |
INSULIN ASPART PROTAMINE/ INSULIN ASPART (insulin aspart prot & aspart (human) inj 100 unit/ml (70-30)) |
NOVOLOG 70/30 |
Diabetes |
INSULIN ASPART PROTAMINE/ INSULIN ASPART FLEXPEN (insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30)) |
NOVOLOG 70/30 |
Diabetes |
NORDITROPIN FLEXPRO (somatropin solution pen-injector 5 mg/1.5 ml, 10 mg/1.5 ml, 15 mg/1.5 ml, 30 mg/3 ml) |
GENOTROPIN, OMNITROPE |
Growth Hormone Deficiency, Short Stature, Growth Failure |
OXANDROLONE (oxandrolone tab 2.5 mg, 10 mg) |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Promotes Weight Gain |
oxandrolone tab 2.5 mg, 10 mg |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Promotes Weight Gain |
SYMJEPI (epinephrine soln prefilled syringe 0.15 mg/0.3 ml (1:2000), 0.3 mg/0.3 ml (1:1000) |
epinephrine solution auto-injector, AUVI-Q |
Anaphylaxis, Severe Hypersensitivity Reactions |
VOTRIENT (pazopanib hcl tab 200 mg (base equiv)) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Cancer |
VYVANSE (lisdexamfetamine dimesylate cap 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
VYVANSE (lisdexamfetamine dimesylate chew tab 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
| Performance Select Drug List Exclusions |
Drug1 |
Alternatives1, 2 |
Drug Class/Condition |
CROTAN (crotamiton lotion 10%) |
permethrin |
Scabies |
DIASTAT ACUDIAL (diazepam rectal gel delivery system 10 mg, 20 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Acute Repetitive Seizures |
diclofenac potassium (migraine) packet 50 mg |
diclofenac tablet |
Migraine |
FLURAZEPAM HYDROCHLORIDE (flurazepam hcl cap 15 mg, 30 mg) |
estazolam, temazepam |
Insomnia |
LIVALO (pitavastatin calcium tab 1 mg, 2 mg, 4 mg) |
atorvastatin, lovastatin, rosuvastatin, pravastatin, simvastatin |
Hyperlipidemia, Hypercholesterolemia |
NORDITROPIN FLEXPRO (somatropin solution pen-injector 5 mg/1.5 ml, 10 mg/1.5 ml, 15 mg/1.5 ml, 30 mg/3 ml) |
GENOTROPIN, OMNITROPE |
Growth Hormone Deficiency, Short Stature, Growth Failure |
ONEXTON (clindamycin phosphate-benzoyl peroxide gel 1.2%-3.75%) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Acne |
OXANDROLONE (oxandrolone tab 2.5 mg, 10 mg) |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Promotes Weight Gain |
oxandrolone tab 2.5 mg, 10 mg |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Promotes Weight Gain |
VOTRIENT (pazopanib hcl tab 200 mg (base equiv)) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Cancer |
VYVANSE (lisdexamfetamine dimesylate cap 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
VYVANSE (lisdexamfetamine dimesylate chew tab 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
| Health Insurance Marketplace (HIM) Drug List Exclusions |
Drug1 |
Alternatives1, 2 |
Drug Class/Condition |
FLURAZEPM HYDROCHLORIDE (flurazepam hcl cap 15 mg, 30 mg) |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Insomnia |
INSULIN ASPART (insulin aspart inj soln 100 unit/ml) |
NOVOLOG |
Diabetes |
INSULIN ASPART FLEXPEN (insulin aspart soln pen-injector 100 unit/ml) |
NOVOLOG |
Diabetes |
INSULIN ASPART PENFILL (insulin aspart soln cartridge 100 unit/ml) |
NOVOLOG |
Diabetes |
INSULIN ASPART PROTAMINE/INSULIN ASPART (insulin aspart prot & aspart (human) inj 100 unit/ml (70-30)) |
NOVOLOG 70/30 |
Diabetes |
NORDITROPIN FLEXPRO (somatropin solution pen-injector 5 mg/1.5 ml, 10 mg/1.5 ml, 15 mg/1.5 ml, 30 mg/3 ml) |
GENOTROPIN, OMNITROPE
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Growth Hormone Deficiency, Short Stature, Growth Failure |
OXANDROLONE (oxandrolone tab 2. mg, 10 mg) |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Weight Gain |
SYMJEPI (epinephrine soln prefilled syringe 0.15 mg/0.3 ml (1:2000), 0.3 mg/0.3 ml (1:1000) |
epinephrine (generic Epi-Pen), AUVI-Q |
Anaphylaxis, Severe Hypersensitivity Reactions |
VOTRIENT (pazopanib hcl tab 200 mg (base equiv)) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Cancer |
VYVANSE (lisdexamfetamine dimesylate cap 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
VYVANSE (lisdexamfetamine dimesylate chew tab 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
| Basic, Enhanced, Multi-Tier Basic and Multi-Tier Enhanced Revisions |
Drug1 |
Preferred Alternatives1, 2 |
Drug Class/Condition |
DIASTAT ACUDIAL (diazepam rectal gel delivery system 10 mg, 20 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Acute Repetitive Seizures |
INSULIN ASPART (insulin aspart inj soln 100 unit/ml) |
NOVOLOG |
Diabetes |
INSULIN ASPART FLEXPEN (insulin aspart soln pen-injector 100 unit/ml) |
NOVOLOG |
Diabetes |
INSULIN ASPART PENFILL (insulin aspart soln cartridge 100 unit/ml) |
NOVOLOG |
Diabetes |
INSULIN ASPART PROTAMINE/INSULIN ASPART (insulin aspart prot & aspart (human) inj 100 unit/ml (70-30)) |
NOVOLOG 70/30 |
Diabetes |
INSULIN ASPART PROTAMINE/INSULIN ASPART FLEXPEN (insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30)) |
NOVOLOG 70/30 |
Diabetes |
NORDITROPIN FLEXPRO (somatropin solution pen-injector 5 mg/1.5 ml, 10 mg/1.5 ml, 15 mg/1.5 ml, 30 mg/3 ml) |
GENOTROPIN, OMNITROPE |
Growth Hormone Deficiency, Short Stature, Growth Failure |
SYMJEPI (epinephrine soln prefilled syringe 0.15 mg/0.3 ml (1:2000), 0.3 mg/0.3 ml (1:1000) |
epinephrine (generic Epi-Pen),
AUVI-Q |
Anaphylaxis, Severe Hypersensitivity Reactions |
VOTRIENT (pazopanib hcl tab 200 mg (base equiv)) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Cancer |
VYVANSE (lisdexamfetamine dimesylate cap 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
VYVANSE (lisdexamfetamine dimesylate chew tab 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg) |
There is a generic equivalent available. Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
ADHD, Binge Eating Disorder |
Drug Tier Changes – As of April 1, 2024
The tier changes listed below apply to members on a managed drug list. Members may pay more for these drugs after April 1, 2024.
| Balanced Drug List Tier Changes |
Drug1 |
Alternatives1, 2 |
Drug Class/Condition |
New Tier |
AMCINONIDE (amcinonide oint 0.1%) |
fluocinonide cream 0.5%, betamethasone dipropionate augmented cream 0.05%, betamethasone dipropionate oint 0.05% |
Inflammatory Conditions |
Non-Preferred Brand |
HYDROCODONE POLISTIREX/CH LORPHENIRAMINE POLISTIREX (hydrocod polst-chlorphen polst er susp 10-8 mg/5 ml) |
benzonatate, hydrocodone bitartrate/homatropine methylbromide, promethazine hydrochloride/dextromethorphan hydrobromide, promethazine/codeine, promethazine/dextromethorphan |
Upper Respiratory Symptoms |
Non-Preferred Brand |
MELPHALAN (melphalan tab 2 mg) |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Cancer |
Non-Preferred Brand |
MIGLITOL (miglitol tab 25 mg, 50 mg, 100 mg) |
acarbose |
Diabetes |
Non-Preferred Brand |
| Performance Drug List Tier Changes |
| Drug1 |
Alternatives1, 2 |
Drug Class/Condition |
New Tier |
HYDROCODONE POLISTIREX/CHLORPHENIRAMINE POLISTIREX (hydrocod polst-chlorphen polst er susp 10-8 mg/5 ml) |
benzonatate, hydrocodone bitartrate/homatropine methylbromide, promethazine hydrochloride/dextromethorphan hydrobromide, promethazine/codeine, promethazine/dextromethorphan |
Upper Respiratory Symptoms |
Non-Preferred Brand |
MELPHALAN (melphalan tab 2 mg) |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Cancer |
Non-Preferred Brand |
MIGLITOL (miglitol tab 25 mg, 50 mg, 100 mg) |
acarbose |
Diabetes |
Non-Preferred Brand |
| Performance Select Drug List Tier Changes |
Drug1 |
Alternatives1, 2 |
Drug Class/Condition |
New Tier |
HYDROCODONE POLISTIREX/CHLORPHENIRAMINE POLISTIREX (hydrocod polst-chlorphen polst er susp 10-8 mg/5 ml) |
benzonatate, hydrocodone bitartrate/homatropine methylbromide, promethazine hydrochloride/dextromethorphan hydrobromide, promethazine/codeine, promethazine/dextromethorphan |
Upper Respiratory Symptoms |
Non-Preferred Brand |
MELPHALAN (melphalan tab 2 mg) |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Cancer |
Non-Preferred Brand |
MIGLITOL (miglitol tab 25 mg, 50 mg, 100 mg) |
acarbose |
Diabetes |
Non-Preferred Brand |
| Health Insurance Marketplace Exchange (HIE) Drug List Tier Changes |
Drug1 |
Alternatives1, 2 |
Drug Class/Condition |
New Tier |
HYDROCODONE POLISTIREX/CHLORPHENIRAMINE POLISTIREX (hydrocod polst-chlorphen polst er susp 10-8 mg/5 ml) |
Please talk to your doctor or pharmacist about other medication(s) available for your condition. |
Upper Respiratory Symptoms |
Non-Preferred Brand |
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.
Additions to Standard Prior Authorization Program – Effective April 1, 2024
Several drug categories and/or targeted medications will be added to the Prior Authorization programs for standard pharmacy benefit plans. This includes ASO groups with a standard UM package and/or subcategory selection with auto updates. For groups that have not selected the auto update, these programs will be available to be added to their benefit design as of the program effective date.
Members were notified about the Prior Authorization Standard Program Changes listed in the table below.
|
Basic, Multi-Tier Basic, Enhanced, Multi-Tier Enhanced Drug Lists, and Health Insurance Marketplace (HIM) |
Drug Category |
Targeted Medication(s)1 Added |
Rapid to Intermediate Acting Insulin PAQL |
Insulin Aspart, Insulin Aspart Mix, Insulin Lispro |
| Balanced, Performance, Performance Select, Basic, Multi-Tier Basic, Enhanced, Multi-Tier Enhanced and Health Insurance Marketplace (HIM) Drug Lists |
Drug Category |
Targeted Medication(s)1 Added |
Therapeutic Alternatives PAQL |
Cambia/diclofenac 50 mg packet, Flurazepam* 15 mg, 30 mg capsules |
Dispensing Limit Changes
BCBSOK’s prescription-drug benefit program includes coverage limits on certain medications and drug categories. Dispensing limits are based on U.S. Food and Drug Administration approved dosage regimens and product labeling.
BCBSOK may send letters to all members with a claim for a drug included in the Dispensing Limit Program, regardless of the prescribed dosage. This means members may receive a letter even though their prescribed dosage doesn’t meet or exceed the dispensing limit.
For the most up-to-date drug list and list of drug dispensing limits, visit the provider pharmacy webpage.
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 or MyPrime.com for more online resources.
Dispensing Limit changes are on the chart below with their effective date. Visit bcbsok.com for the most up-to-date drug lists and dispensing limits.
|
Balanced, Performance, Performance Select, Basic, Multi-Tier Basic, Enhanced, Multi-Tier Enhanced and Health Insurance Marketplace (HIM) Drug Lists |
Effective Date |
Program |
Target Agent |
Dispensing Limit |
4/1/2024 |
Xdemvy QL |
Xdemvy (lotilaner ophth) soln 0.25% |
1 bottle per 50 days |
Members were not lettered on these changes.
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.
|
Product(s) No Longer Covered1 |
Condition |
Covered Alternative(s)1, 2 |
DICLOFENAC POTASSIUM 25 MG TABLETS |
Pain |
DICLOFENAC POTASSIUM 50 MG, MELOXICAM, IBUPROFEN, NAPROXEN |
Pharmacy Benefits Updates
Reminder: BCBSOK Offers LifeScan as Preferred Option for Glucose Management
New for Members with Diabetes: LifeScan® One Touch test strips and supplies are now 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.
- Contour and Contour Next test strips remain preferred options for managing diabetes.
- LifeScan’s OneTouch test strips have been removed from the Glucose Test Strip Step Therapy Quantity Limits program effective Jan. 1, 2024.
Free Glucose Monitor: Members may use a coupon in our member flier for a free, blood-glucose monitor from either preferred vendor.
Reminder: BCBSOK’s Updated Approach to Managing GLP-1 Agonist Medications
BCBSOK 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 process for some of our members with diabetes.
Note: Members may have received a letter regarding this change. For more information, review the full article.
