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February 2018
High-cost insulins with comparable alternatives are included among Blue Cross, BCN’s Custom Select Drug List exclusions
To address the high cost of drugs and provide the best value for our members, Blue Cross Blue Shield of Michigan and Blue Care Network commercial (non-Medicare) plans exclude drugs from the Custom Select Drug List when there is a more cost-effective alternative available.
Insulin exclusions
Blue Cross and BCN commercial plans won’t cover all formulations of the following insulin products for the Custom Select Drug List, effective Jan. 1, 2018:
- Apidra®, Apidra® Solostar®
- Humalog® (except Junior KwikPen), Humalog® Mix
- Humulin® (except U-500), Humulin® KwikPen®
Members who use these insulin products can continue to fill prescriptions for them through March 1, 2018. This will give them the opportunity to talk to their providers about treatment options.
Insulin products of the same type are interchangeable and work the same way to lower A1c. The following table shows what is and isn’t covered and the cost implications:
Insulin products not covered beginning Jan. 1, 2018 |
Cost to Blue Cross member (PPO) |
Cost to BCN member (HMO) |
Apidra®, Apidra® Solostar |
Full cost (not covered) |
Full cost (not covered) |
Humalog® (except Junior KwikPen), Humalog® Mix |
Humulin® (except U-500), Humulin® Mix |
Covered alternatives |
Cost to Blue Cross member |
Cost to BCN member |
Novolin® (all forms) |
Preferred brand copayment |
Generic copayment |
Novolog®, Novolog® Mix |
Other exclusions
In addition to the high-cost insulin, we’ve listed other drugs below that we removed from our Custom Select Drug List, effective Jan. 1, 2018. And we’ve also listed some covered alternatives:
Common drug use/
drug class |
Drug not covered beginning Jan. 1, 2018 |
Alternatives |
Vaginal antifungal |
AVC® vaginal cream |
- Fluconazole (Diflucan®) oral
- Terconazole (Terazol®) vaginal cream and suppository
|
Urinary antispasmodic |
Enablex® |
- Oxybutynin (Ditropan®, Ditropan®XL)
- Tolterodine (Detrol®, Detrol®LA)
- Trospium (Sanctura®, Sanctura®XR)
|
Migraine treatment |
Ergomar® |
- Dihydroergotamine (D.H.E. 45®, Migranal®)
- Ergotamine/caffeine (Cafergot®, Migergot®)
|
Pain management |
Fenortho® 200mg, 400mg |
Generic oral nonsteroidal anti-inflammatories (NSAIDs)
Examples include:
- Diclofenac (Voltaren®)
- Etodolac (Lodine®, Lodine® XL)
- Fenoprofen 400mg (Nalfon®)
- Ibuprofen (Motrin® – Rx only)
- Meloxicam (Mobic®)
- Naproxen (Naprosyn®)
- Piroxicam (Feldene®)
|
Gastrointestinal |
Kristalose® |
Lactulose |
Respiratory treatment |
Nebusal® |
Generic sodium chloride inhalation 3%, 7% and 10% |
Bowel preparation and cleansing |
Osmoprep®
Prepopik® |
Generic polyethylene glycol-electrolyte solution (Colytev®, Golytely®, Halflytely®-bisacodyl, Nulytely®) |
Digestive enzymes |
Pancreaze®
Pertyze®
Viokace® |
Pancrelipase (Creon®**, Zenpep®**) |
Vitamin |
Phytonadione syringe |
Phytonadione ampule |
Insomnia |
Seconal® |
- Eszopiclone (Lunesta®)
- Temazepam (Restoril®)
- Zaleplon (Sonata®)
- Zolpidem (Ambien®, Ambien®CR)
|
Topical antiviral |
Zovirax® cream |
- Penciclovir cream (Denavir®**)
- Famciclovir tablets (Famvir®)
- Valacyclovir tablets (Valtrex®)
|
**Indicates that there is no generic version of the alternative drug currently available
We’ll continue to identify certain high-cost drugs and will stop covering them when there are more cost-effective alternatives available for our commercial members.
The Custom Select Drug List is found on bcbsm.com, on our Pharmacy Services page. |
