Pharmacy Updates

Please note the upcoming changes to BlueChoice HealthPlan’s pharmacy benefits. This information does not apply to Marketplace product lines.
 
Good News!
We will begin covering esomeprazole (generic Nexium) effective Dec. 1, 2015. Groups can share this short coverage update with their employees, if they choose.
 
Change in Group Notification Policy
To help control rising pharmacy costs, we will be more proactive in applying utilization management (UM) to drugs (specialty or non-specialty) that are new to the market. We will apply UM before significant utilization occurs. For more than a year, we have proactively added new-to-market specialty drugs to our comprehensive Specialty Drug List. We implement UM [such as prior authorization (PA)] when appropriate. We will apply this same process to non-specialty drugs. When utilization may occur before we can apply our UM programs, we will grandfather current users for a period of time. This is to allow appropriate notification to groups and members.
 
Formulary, Quantity Management Program and PA Program Changes
We will make changes to the formulary, Quantity Management and PA programs  beginning Jan. 1, 2016, unless noted otherwise. We will send letters to members who are negatively impacted by these changes.
 
For more information, please contact your BlueChoice^® representative.