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

As we’ve stated before, our goal at Blue Cross Blue Shield of Michigan and Blue Care Network is to provide our members with safe, high-quality prescription drug therapies. We continually review our practices regarding prescription drugs to provide the best value for our members, control costs and make sure our members are using the right drug for the right situation.

Starting Jan. 1, 2023, we’ll change how we cover some medications on the drug lists associated with our prescription drug plans. We’ll send letters to notify affected members, their groups and their health care providers about these changes.

Read the following for an explanation of these changes:

Drugs 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. For drugs with a generic equivalent available, the example brand names are listed for reference. If members fill a prescription for one of these drugs on or after Jan. 1, 2023, they’ll be responsible for the full cost.

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

Drugs that will have a higher copayment

The brand-name drugs that will have a higher copayment are listed along with suggested covered preferred alternatives that have similar effectiveness, quality and safety. When pharmacies fill prescriptions with preferred alternatives, the generic equivalents are dispensed, if available. Additional coverage requirements may apply for preferred alternatives.

**Nonpreferred brand-name drugs aren’t covered for members with a closed benefit.
***Applies to Blue Care Network only

Drugs that will have quantity limit changes
These drugs will have changes to the amount that can be filled.

Preventive drug coverage updates

Under the Affordable Care Act, most health plans must cover certain preventive services and prescription drugs with no out-of-pocket costs, based on recommendations by the U.S. Preventive Services Task Force.

The USPSTF is a panel of national experts in prevention and evidence-based medicine. The panel works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services, such as screenings, counseling services and preventive medications.

The USPSTF no longer recommends the use of aspirin for prevention of cardiovascular disease or colorectal cancer, so we’re no longer covering aspirin 325mg. Aspirin 81mg will remain covered for members at high risk of preeclampsia per the USPSTF’s recommendations.

If members fill a prescription for aspirin 325 mg on or after Jan. 1, 2023, they’ll be responsible for the full cost. Aspirin 325 mg is available for purchase over the counter.

For a complete list of preventive drugs and coverage requirements go to bcbsm.com/pharmacy.