BCBSM makes changes to Medicare Advantage formulary

To reduce 2014 plan year costs, our Medicare Advantage Pharmacy Services team made some significant changes to the Part D formulary.

Because of the extent of these changes, we notified current members in October during annual enrollment. We encouraged them to check our formulary to see if their current drugs will be affected by these changes.

Our members may reach out to you about these changes and may request an exception.

Beginning Jan. 1, 2014, please consult our formulary before prescribing a medication to our members. Here are the key changes:

• The changes affect your patients’ cost-sharing and access to drugs they’re currently using. Some drugs will not be covered, beginning in 2014.
• We’re encouraging use of generic drugs when appropriate and focusing on drugs that provide the best treatment.
• We moved many drugs to a high drug tier, resulting in higher out-of-pocket costs for affected members, while other covered drugs will have new requirements for use, such as prior authorization or step therapy.
• To promote drug safety, we’ve removed many high-risk medications from our formulary and imposed higher cost-sharing on other high-risk medications by moving them into a different drug tier or placing additional restrictions on their use. In some cases, you may be required to check with us before prescribing these drugs. We’re also encouraging members to talk with you to see if there’s a lower-risk option that would still effectively treat their condition.
• Implemented quantity limits for certain drugs. If you believe your patient needs a larger quantity of a specific drug, the patient may be eligible for a transition supply for the first 90 days of 2014.

Tier exceptions will be available before Dec. 31, 2013, for our members. Members can call Member Services at the number on the back of their ID cards to request a tier exception.

Providers can request coverage determinations for members in advance of the new plan year.

Our 2014 formulary can be found online at bcbsm.com/medicare.

If you have any questions or concerns, please contact your provider consultant.