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January 2017

We’re changing how we process drugs with gender edits, starting Jan. 1

To meet federal guidelines, gender-specific coverage edits on the following drugs and drug categories will be modified, starting Jan. 1, 2017:

Drugs

  • Testosterone
  • Folic acid
  • Tamoxifen
  • Raloxifene

Drug categories

  • Contraceptives
  • Erectile dysfunction

In addition, starting Jan. 1, drugs used to treat erectile dysfunction will be coded to remove gender-specific coverage references.

Why are we making these changes?
We’re making these changes to meet the requirements of Section 1557 of the Affordable Care Act. The final rule, which was issued this year, prohibits discrimination on the basis of race, color, national origin, sex, age or disability in health care programs or activities that receive federal financial assistance.

For more information, call claims processor Express Scripts at 1-800-922-1557 from 8 a.m. to 5:30 p.m. Monday through Friday. For additional support, call the Pharmacy Services Clinical Help Desk at 1-800-437-3803.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.
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