Some generic statin drugs to be covered at zero cost share for select members

Effective Dec. 1, 2017, Blue Cross Blue Shield of Michigan and Blue Care Network will cover low- to moderate-dose generic statin drugs at zero cost share when they’re prescribed for members between the ages of 40 and 75.

We’re doing this because the U.S. Preventive Services Task Force recommends that adults without a history of cardiovascular disease use a low- to-moderate-dose statin to prevent CVD events and mortality when they meet the following criteria:

• They’re between the ages of 40 and 75.
• They have one or more CVD risk factors, such as dyslipidemia, diabetes, hypertension or smoking.
• Their calculated 10-year risk of a CVD event is 10 percent or greater.

This change applies to Blue Cross and BCN commercial (non-Medicare) members and doesn’t apply to grandfathered, retiree or religious-accommodated groups.

The low- to moderate-dose generic statin drugs we’ll cover at zero cost share, when members meet plan requirements and have a prescription, include:

• Atorvastatin (brand name Lipitor^®) — Less than or equal to 20 mg
• Fluvastatin (brand name Lescol^®/XL) — Less than or equal to 80 mg
• Lovastatin (brand name Mevacor^®) — Less than or equal to 40 mg
• Pravastatin (brand name Pravachol^®) — Less than or equal to 80 mg
• Rosuvastatin (brand name Crestor^®) — Less than or equal to 10 mg
• Simvastatin (brand name Zocor^®) — Less than or equal to 40 mg

Members outside of the 40-to-75 age range will continue to receive generic statins at their applicable cost share.

Note: Quantity limits apply. Refer to the Quantity Limit Program document here. If a patient’s use of these drugs exceeds our quantity limits, you may request approval to deviate from the dosing guidelines.