July 26, 2017
Pharmacy Program Quarterly Update: Changes Effective Oct. 1, 2017
Select Products Excluded from Rx Coverage
Effective Oct. 1, 2017, select prescription drugs that are available over-the-counter (OTC) will be added to the OTC equivalent exclusion drug list. Because these equivalent products with the same active ingredients in the same strength are available OTC without a prescription, the prescription versions of these medications will no longer be covered under the prescription drug benefit.
For groups with the OTC equivalent exclusion included in their prescription drug benefits, members with recent prescription history for these products will be notified of this change.
Now Available OTC1
Condition Used for
Differin Gel 0.1%
Differin Gel 0.1%
Two new PA programs were added to the standard PA program effective July 1, 2017, for all standard pharmacy benefit plans, for ASO groups that have selected auto updates and upon renewal for non-ASO groups. The Injectable Atopic Dermatitis PA program includes the target drug Dupixent. The Emflaza PA program includes the target drug Emflaza. For ASO groups that have not selected auto updates, these programs are available for selection. Contact your BCBSTX representative for more information.
PA and ST Program Changes Effective Oct. 1, 2017 (ASO Groups)
Effective Oct. 1, 2017, several drug categories and/or targeted medications will be added to the PA program for ASO groups that have selected auto updates. For groups that have not selected auto updates, these programs will be available for selection beginning Oct. 1, 2017. Contact your BCBSTX representative for more information.
Please note: As a reminder, the PA and ST programs for standard pharmacy benefit plans correlate to the member’s drug list. Not all standard PA and ST programs may apply, based on the member’s current drug list. A list of PA and ST programs per drug list is posted on the member prescription drug plan information section of bcbstx.com.
Drug categories added to current pharmacy PA standard programs, effective Oct. 1, 2017 (ASO members only):
Targeted drugs added to current pharmacy PA standard programs, effective Oct. 1, 2017 (ASO members only):
Targeted mailings were sent to ASO members affected by prior authorization program changes.
View the most up-to-date drug list and list of drug dispensing limits on bcbstx.com.
If you have any questions regarding these changes, contact your BCBSTX representative.
1Third-party brand names are the property of their respective owner.
2This list is not all inclusive. Other medications may be available in this drug class.
*These pharmacy changes apply to members and groups with prescription drug benefits administered through Blue Cross and Blue Shield of Texas (BCBSTX).
BCBSTX contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.