The Record - 2015 Blue Cross formulary changes focus on high-risk medications for older adults

2015 Blue Cross formulary changes focus on high-risk medications for older adults

As of Jan. 1, 2015, changes to the Blue Cross Blue Shield of Michigan Medicare Part D drug formulary will take effect for certain high-risk medications in older adults.

Blue Cross made these formulary changes based on the American Geriatrics Society’s endorsed list of medications deemed potentially inappropriate for older adults. These changes align with the Centers for Medicare and Medicaid Services’ Five-Star Quality Rating System to improve the quality of patient care by decreasing the use of these medications in the Medicare population.

While some medications did not change tiers, they have added criteria which require a prior authorization. For example, amitriptyline is still a tier 2 drug, but it will only be covered if treatment failure occurs with an antidepressant that has fewer anticholinergic side effects.

Below is a summary of the 2015 Blue Cross formulary changes for high-risk medications. “PA” stands for prior authorization and “QL” stands for quantity limit.

Drug name

Change for standard
or plus plans

Change for group plans

Zaleplon

Tier 2 with PA, QL

Zolpidem, temazepam

Removed from formulary

Tier 2 with PA, QL

Menest (1.25 mg, 2.5 mg)

Tier 4 with PA

Estradiol (0.5 mg, 1 mg, 2 mg)

Tier 2 with PA

Alora^® patch, Climara Pro^® patch, CombiPatch^®, Menest (0.3 mg, 0.625 mg), Prefest tablets, Premarin^®tablets, Prempro tablets and Vivelle-Dot^® patch

Removed from formulary

Tier 4 with PA

Estradiol patch

Removed from formulary

Tier 2 with QL

Estradiol-norethindrone acetate tablets, estropipate tablets, Jinteli^® tablets

Removed from formulary

Tier 2 with PA

Cyclobenzaprine

Tier 2 with PA

Digoxin (only for total daily doses more than 0.125mg)

Tier 2 with PA

Megestrol

Tier 2 with PA

Cyproheptadine, diphenhydramine

Tier 2 with PA

Thioridazine

Tier 2 with PA

Amitriptyline, clomipramine, imipramine, trimipramine, doxepin

Tier 2 with PA

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.