Blue Medicare Rx Medicare Part D Formulary Changes 2012 to 2013

December 18, 2012

The 2013 Medicare Part D annual Open Enrollment Period (OEP) began October 15, 2012 and ended on December 7, 2012. On October 23, 2012 the 2013 Blue MedicareRx Blue Cross and Blue Shield of Texas (BCBSTX) Medicare Part D formulary was granted ‘conditional approval’ by the Centers for Medicare and Medicaid Services (CMS) and as with all Medicare Part D drug plans you can expect a number of formulary and utilization management changes for 2013. Some of the changes were mandated by CMS (safety concerns, drugs that no longer meet CMS’ definition of a ‘Part D medication’, etc.) but others were a result of dynamic changes in the pharmaceutical marketplace. The Blue MedicareRx 2013 Part D formulary changes include addition of some new drug therapies as well as the migration to some important generic equivalents (e.g. BONIVA tablets, LIPITOR, MAXALT, and TRICOR) that have and/or will become available in 2013.

A copy of 2012 to 2013 formulary changes (i.e. drug removals and new Prior Authorization and Step Therapy utilization management programs) will be included in the Annual Notice of Change (ANOC) that is sent to all current members of HISC’s Medicare Part D plans. In addition, individual member letters were mailed in mid-November 2012, alerting them of 2013 formulary changes (removals, tier changes, new utilization management programs, etc.) affecting them. Finally, a copy of the 2013 formulary is already available on the BCBSTX provider website at bcbstx.com/provider in time for the start of the Medicare Part D OEP. Please refer to our list below for a handy reference to the Top 30 medications that will be impacted by a change to the 2013 formulary and therefore, have the most potential to affect current members. Coverage determinations for changes, when applicable, can be submitted by the prescribing physician after December 1, 2012 with an effective date of January 1, 2013.

Affected Drug(s)	Description of Change	Formulary Alternative, if Applicable
amphetamine/dextroamphetamine tabs	Is not covered on our 2013 formulary	amphetamine/dextroamphetamine ER capsule or Adderall XR capsule
ANDROGEL	Is on our formulary and newly requires prior authorization before we will continue payment for this drug. Quantity limits may newly apply.	Check with your doctor
nevirapine tab, 200 mg	Generic	5/27/12
ATRIPLA	Is on our formulary; however quantity limits may newly apply	On formulary, quantity limits may apply
AVONEX kit, AVONEX PEN	Is on our formulary and newly requires prior authorization before we will continue payment for this drug. Quantity limits may apply.	Check with your doctor
BONIVA tabs	Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.	ibandronate
BRILINTA	Is not covered on our 2013 formulary	clopidogrel or Effient
CARBATROL	Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.	carbamazepine SR
carbinoxamine liquid, tabs, Arbinoxa	Is not covered on our 2013 formulary	Check with your doctor
COPAXONE	Is on our formulary and newly requires prior authorization before we will continue payment for this drug. Quantity limits may apply.	Check with your doctor
cyproheptadine syrup, tabs	Is not covered on our 2013 formulary	levocetirizine tabs
DERMOTIC	Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.	fluocinolone acetonide (otic) oil 0.01%
diphenoxylate/atropine tabs, Lonox, Lofene	Is not covered on our 2013 formulary	loperamide capsule
FEMARA	Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.	letrozole
flunisolide nasal spray	Is not covered on our 2013 formulary	fluticasone, triamcinolone acetonide, or Nasonex nasal spray
guanfacine tab, 200 mg	Generic	5/27/12
haloperidol concentrate, tabs	Is on our formulary and newly requires prior authorization before we will pay for this drug.	Check with your doctor
hydroxyzine pamoate caps	Is not covered on our 2013 formulary	levocetirizine tabs
ISENTRESS	Is on our formulary; however quantity limits may newly apply	On formulary, quantity limits may apply
LIPITOR	Is not covered on our 2013 formulary as there are generic equivalents and/or generic alternatives available. When you choose generic drugs, you get prescription medications that are: FDA approved and regulated, Equal to brand-name drugs in terms of safety and effectiveness, and Less expensive.	atorvastatin
LODOSYN	Is not covered on our 2013 formulary	carbidopa/levodopa, amantadine, Apokyn, bromocriptine, Comtan, pramipexole, ropinirole, or selegiline
MAXALT, MAXALT-MLT	Is not covered on our 2013 formulary	naratriptan or sumatriptan tablets
meprobamate	Is not covered on our 2013 formulary	buspirone
MESTINON TIMESPAN	Is not covered on our 2013 formulary	pyridostigmine regular release tablet
NORVIR caps, solution, tabs	Is on our formulary; however quantity limits may newly apply	On formulary, quantity limits may apply
olanzapine	Is on our formulary and newly requires prior authorization before we will pay for this drug. Quantity limits may apply.	Check with your doctor
ISENTRESS	Is on our formulary; however quantity limits may newly apply	On formulary, quantity limits may apply
PERPHENAZINE/AMITRIPTYLINE	Is not covered on our 2013 formulary	quetiapine, risperidone, ziprasidone
quetiapine	Is on our formulary and newly requires prior authorization before we will pay for this drug. Quantity limits may apply.	Check with your doctor
REVATIO tabs	Is not covered on our 2013 formulary	Adcirca, Letairis, or Tracleer
SEROQUEL	Is on our formulary and newly requires prior authorization before we will pay for this drug. Quantity limits may apply.	Check with your doctor
SUBOXONE	Is on our formulary; however quantity limits may newly apply	On formulary, quantity limits may apply
TESTIM	Is not covered on our 2013 formulary	Androderm, Androgel or Fortesta
testosterone cypionate	Is on our formulary and newly requires prior authorization before we will continue payment for this drug. Quantity limits may newly apply.	Check with your doctor
TRICOR	Is not covered on our 2013 formulary	fenofibrate, Lipofen, or TriLipix
TRUVADA	Is on our formulary; however quantity limits may newly apply	On formulary, quantity limits may apply
VALTURNA	Has been discontinued by the manufacturer	eprosartan, irbesartan, or losartan