IBC eBulletin - Prescription drug coverage updates

We are making changes to the Select Drug Program^® formulary and updates to the way we manage Suboxone^® and Subutex^® (buprenorphine), which are narcotic medications used to treat drug dependencies and addictions.

Changes to the formulary
Effective July 1, 2010, we are making the following changes to our Select Drug Program formulary:

• We are adding 13 generic drugs that became available in the marketplace, which gives members access to more affordable medications to treat their conditions.

• We are adding brand drugs to the formulary, all of which have been approved by the Pharmacy and Therapeutics Committee, as formulary drugs.

• We are moving some brand drugs to the non-formulary level. This means that the cost for these drugs will be at the highest level of cost-sharing as of July 1, 2010.

Click here to view the list of drugs being added or moved. You can also view the Select Drug Program Formulary guide by clicking here.

Select Drug Program formulary members will be notified of these changes in the August 2010 issue of Update magazine. Members who are currently taking a drug that is being deleted from the formulary and members who  do not  get Update magazine will receive a letter notifying them of these changes.

Safe prescribing procedures update – Suboxone and Subutex
Prescription medications are necessary to effectively treat certain medical conditions; however, they have the potential to be unsafe when not used properly. Our Safe Prescribing Procedures helps to ensure that our members are using prescriptions drugs safely. The following changes to the Safe Prescribing Procedures for Suboxone and Subutex will take effect August 1, 2010:

• Prior authorizations. We are implementing a prior authorization for Suboxone and Subutex. If approved, those prior authorizations will include an expiration date at the time the approval is made. If the member’s doctor wants him or her to continue the drug therapy after the expiration date, a new request must be submitted and the member’s doctor must receive an approval to continue the coverage of current drug therapy.

• Quantity limits. We are adding quantity limits to Suboxone and Subutex. If members attempt to fill a prescription that exceeds the quantity limit, their pharmacist is permitted to fill the prescription only up to the quantity limit. If the member’s doctor determines that his or her therapy requires a larger dose of medication than the established quantity limit for the drug, the doctor may request a Quantity Limit Exception. Doctors must receive an approval for the exception for members to receive coverage  at a larger dose.

Members who are taking Suboxone and Subutex will receive a letter notifying them of this change and how it affects them. All other members will be notified through Update magazine.

Preferred insulin brand reminder
In February, we announced that effective April 1, 2010, Novolin^® and Novolog^® would be the preferred insulin drugs for Independence Blue Cross prescription drug programs. We also announced that any non-preferred brands of insulin, including Humulin^®, Humalog^®, ReliOn^®/Novolin^®, and Apidra^®, would be subject to prior authorization. The prior authorization requirement for non-preferred brands of insulin went into effect for new prescriptions on April 1, 2010, and will go in to effect for existing prescriptions on July 1, 2010.

Prior authorization requests will be reviewed in accordance with our established criteria, and, if approved, non-preferred insulin will be covered at the appropriate cost-sharing level. If denied, non-preferred insulin will not be a covered benefit. We continue to encourage members to talk to their doctor to find out what insulin is right for them.

You may forward this email to customers who are interested in receiving updates.

If you have any questions, please contact your Indpendence Blue Cross account executive.

Click here to view the member letter.