Starting Jan. 1, 2022, we’ll change how we cover some drugs

As we’ve let you know before, Blue Cross Blue Shield of Michigan and Blue Care Network want to make sure members receive safe, high-quality care that meets their needs. To accomplish this, we’re making some changes to how we cover some drugs on the Clinical, Custom, Custom Select and Preferred Drug lists, starting Jan. 1, 2022. We’ll send letters to affected members and their groups and providers.

The following is a list of these changes:

Drugs on the Clinical and Custom Drug Lists that won’t be covered

We’ll no longer cover the drugs in the table below. Unless noted, both the brand name and available generic equivalents won’t be covered. If members fill a prescription for one of these drugs on or after Jan. 1, 2022, they’ll be responsible for the full cost.

The drugs that won’t be covered are listed, along with the covered preferred alternatives that have similar effectiveness, quality and safety. When pharmacies fill prescriptions with preferred alternatives, the generic equivalents are dispensed, if available. The example brand names of preferred alternatives are provided for reference. Additional coverage requirements may apply for preferred alternatives, such as prior authorization.

¹Authorized brand alternatives (authorized generics) are drugs that are considered brand-name drugs and don’t have generic equivalents. These drugs are the same as the brand-name drugs but aren’t true generic drugs. The respective brand copayment ill apply for these drugs.

Drugs on Custom Drug List that will have a higher copayment

The following brand-name drugs will have a higher copayment, starting Jan. 1, 2022. We’ve listed each along with the preferred alternatives that have similar effectiveness, quality and safety, but lower copays. When pharmacies fill prescriptions with preferred alternatives, the generic equivalents are dispensed, if available. The example brand names of preferred alternatives are provided for reference. Additional coverage requirements may apply for preferred alternatives, such as prior authorization.

Drugs on the Custom Select Drug List that won’t be covered

We’ll no longer cover the following brand-name and generic drugs. Unless noted, both the brand name and available generic equivalents won’t be covered. If members fill a prescription for one of these drugs on or after Jan. 1, 2022, they’ll be responsible for the full cost.

The drugs that won’t be covered are listed along with the covered preferred alternatives that have similar effectiveness, quality and safety. When pharmacies fill prescriptions for preferred alternatives, the generic equivalents are dispensed, if available. The example brand names of preferred alternatives are provided for reference. Additional coverage requirements may apply for preferred alternatives, such as prior authorization.

¹Authorized brand alternatives (authorized generics) are drugs that are considered brand-name drugs and don’t have generic equivalents. These drugs are the same as the brand-name drugs but aren’t true generic drugs. The respective brand copayment ill apply for these drugs.

Drugs on the Custom Select Drug List that will have a higher copayment

The following brand-name drugs will have a higher copayment, starting Jan. 1, 2022. We’ve listed each along with the preferred alternatives that have similar effectiveness, quality and safety, but lower copays. When pharmacies fill prescriptions for preferred alternatives, the generic equivalents are dispensed, if available. The example brand names of preferred alternatives are provided for reference. Additional coverage requirements may apply for preferred alternatives, such as prior authorization.

Drugs on the Preferred Drug List that won’t be covered

We’ll no longer cover the following drugs. Unless noted, both the brand name and available generic equivalents won’t be covered. If members fill a prescription for one of these drugs on or after Jan. 1, 2022, they’ll be responsible for the full cost.

The drugs that won’t be covered are listed along with the covered preferred alternatives that have similar effectiveness, quality and safety. When pharmacies fill prescriptions with preferred alternatives, the generic equivalents are dispensed, if available. The example brand names of preferred alternatives are provided for reference. Additional coverage requirements may apply for preferred alternatives, such as prior authorization.

¹Authorized brand alternatives (authorized generics) are drugs that are considered brand-name drugs and don’t have generic equivalents. These drugs are the same as the brand-name drugs but aren’t true generic drugs. The respective brand cost share will apply for these drugs.

Drugs on the Preferred Drug List that will have a higher copayment

The following brand-name drugs will have a higher copayment, starting Jan. 1, 2022. We’ve listed each along with the preferred alternatives that have similar effectiveness, quality and safety, but lower copays. When pharmacies fill prescriptions with preferred alternatives, the generic equivalents are dispensed, if available. The example brand names of preferred alternatives are provided for reference. Additional coverage requirements may apply for preferred alternatives, such as prior authorization.

**A closed prescription drug benefit doesn’t cover non-preferred brand drugs. Only generic and preferred brand drugs are covered.