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November 2023
Starting Jan. 1, we’ll change how we cover some drugs on Clinical, Custom, Custom Select and Preferred drug lists
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 prescription drugs so we can provide the best value for our members, control costs and make sure our members are using the right drugs for the right situations.
Starting Jan. 1, 2024, we’ll change how we cover some medications on the Clinical, Custom, Custom Select and Preferred drug lists. We’ll send letters to notify affected members, their groups and their health care providers about these changes.
Drugs that won’t be covered on the Clinical, Custom and Custom Select Drug lists
We’ll no longer cover the drugs listed in the table below. Unless noted, both the brand name and available generic equivalents won’t be covered. If a member fills a prescription for one of these drugs on or after Jan. 1, 2024, 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 won’t be covered |
Affected drug lists |
Common use or drug class |
Preferred alternatives |
Generic doxycycline monohydrate 75mg capsule |
Custom Select |
Tetracycline antibiotic |
- Generic doxycycline hyclate capsule; 100mg tablet
- Generic doxycycline monohydrate 50mg, 100mg capsule; 50mg, 75mg, 100mg tablet
|
APO-varenicline |
Clinical, Custom, Custom Select |
Smoking cessation |
Generic varenicline tartrate (Chantix®) |
Copaxone® 20mg/mL
(brand glatiramer) |
Custom Select |
Multiple sclerosis |
Generic glatiramer 20mg/mL, 40mg/mL (Glatopa®) |
Drugs that will have a higher copayment on Clinical, Custom and Custom Select drug lists
The brand-name drugs that will have a higher copayment are listed in the table below 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.
Drugs that will have a higher copayment** |
Affected drug lists |
Common use or
drug class |
Preferred alternatives |
Generic doxycycline monohydrate 75mg capsule |
Custom
(HMO only) |
Tetracycline antibiotic |
- Generic doxycycline hyclate capsule; 100mg tablet
- Generic doxycycline monohydrate 50mg, 100mg capsule; 50mg, 75mg, 100mg tablet
|
Generic doxycycline monohydrate 150mg tablet |
Custom
(HMO only)
Custom Select (HMO only) |
Copaxone® 20mg/mL
(brand glatiramer) |
Clinical, Custom |
Multiple sclerosis |
Generic glatiramer 20mg/mL, 40mg/mL (Glatopa®) |
**Nonpreferred brand drugs aren’t covered for members with a closed benefit.
Brand-name drugs no longer covered with generic copay on HMO Custom Drug List
On some of our drug lists, select brand-name drugs are covered at a generic copay and the generic equivalent drug isn’t covered. These brand-name drugs will no longer be covered at the generic copay. Members can fill prescriptions with the generic equivalent.
Brand-name drug |
Affected drug lists |
Covered generic equivalent |
Adderall® XR |
Custom
(HMO only) |
Dextroamphetamine/ amphetamine ER capsule |
Drugs that won’t be covered on the Preferred Drug List
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 a member fills a prescription for one of these drugs on or after Jan.1, 2024, they’ll be responsible for the full cost.
The drugs that won’t be covered are listed in the table below 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 won’t be covered |
Common use or drug class |
Preferred alternatives |
Adhansia XR® |
Attention-deficit/hyperactivity disorder (ADHD) |
- Generic methylphenidate (such as Ritalin® LA, Concerta®)
- Generic dexmethylphenidate (such as Focalin® XR)
- Generic amphetamine/ dextroamphetamine (such as Adderall® XR)
- Lisdexamphetamine (Vyvanse®)
|
Aklief®, Arazlo® |
Acne vulgaris |
- Generic adapalene 0.1% cream, gel (Differin®)
- Generic adapalene-benzoyl peroxide gel 0.1-2.5% (Epiduo®)
- Generic tazarotene 0.1% cream, gel (Tazorac®)
|
Aplenzin®, Forfivo XL®, bupropion ER 450mg (authorized brand alternative for Forfivo XL®) |
Depression |
Generic bupropion ER (Wellbutrin® SR/XL) |
APO-varenicline |
Smoking cessation |
Generic varenicline tartrate (Chantix®) |
Copaxone® 20mg/mL (brand glatiramer) |
Multiple sclerosis |
Generic glatiramer 20mg/mL, 40mg/mL (Glatopa®) |
Generic dapsone 7.5% gel (Aczone®) |
Acne vulgaris |
Generic dapsone 5% gel (Aczone®) |
Evekeo ODT® |
Attention-deficit/hyperactivity disorder – ADHD |
- Generic dextroamphetamine solution (ProCentra®)
- Generic methylphenidate solution, chewable tablet (Methylin®)
|
FloLipid® |
Hypercholesterolemia |
- Generic statin (such as rosuvastatin (Crestor®)
- Fluvastatin (Lescol XL®)
- Atorvastatin (Lipitor®)
- Pravastatin (Pravachol®)
- Simvastatin (Zocor®)
|
Impoyz® |
High-potency topical steroid |
Generic high-potency topical steroid (such as betamethasone 0.5% cream, lotion; desoximetasone 0.25% cream, diflorasone 0.5% cream, flucinonide 0.5% cream, lotion; halcinonide 0.1% cream) |
Lexette®, Ultravate® 0.05% lotion |
Ultra-high-potency topical steroid |
Generic ultra-high-potency topical steroid (such as clobetasol 0.05% cream, foam, spray; flucinonide 0.1% cream, halobetasol 0.05% cream, lotion) |
Kristalose® packet |
Constipation |
Generic lactulose oral solution |
Generic meclizine 50mg tablet |
Vertigo, motion sickness |
Generic meclizine 12.5mg, 25mg tablet |
Ortikos® |
Crohn’s disease |
Generic budesonide 3mg capsule |
Osmolex ER® |
Parkinson’s disease |
Generic amantadine tablet, solution |
Oxaydo® |
Pain |
Generic oxycodone tablet |
Phenergan Fortis® 25mg/5mL syrup |
Nausea and vomiting |
Generic promethazine 6.25mg/5mL syrup |
Roszet® |
Hypercholesterolemia |
Generic ezetimibe (Zetia®) plus generic rosuvastatin (Crestor®) |
Sernivo® |
Moderate-potency topical steroid |
Generic moderate-potency topical steroid (such as betamethasone 0.12% foam, desoximetasone 0.05% cream, fluticasone 0.05% cream, lotion; mometasone 0.1% cream, lotion; triamcinolone 0.2% spray) |
Sprix® |
Pain |
Generic ketorolac tablet, injection |
Generic tavaborole (Kerydin®) |
Onychomycosis (nail fungus) |
Ciclodan topical solution |
Teriparatide 620 mcg/2.48mL injection |
Osteoporosis |
Forteo®, Tymlos® |
Tosymra® |
Migraine |
- Generic triptan (such as sumatriptan nasal spray (Imitrex®)
- Zolmitriptan 5mg nasal spray (Zomig®)
- Orally disintegrating tablet (Zomig ZMT®)
- Rizatriptan orally-disintegrating tablet (Maxalt-ODT®)
|
Wynzora® |
Plaque psoriasis |
- Generic calcipotriene/betamethasone ointment (Taclonex®)
- Generic tazarotene 0.1% cream (Tazorac®)
- Enstilar®
|
Xerese® |
Herpes labialis (cold sores) |
Generic acyclovir 5% ointment |
Zilxi® |
Rosacea |
- Generic azelaic 15% gel (Finacea®)
- Generic metronidazole 0.75% cream, lotion (MetroCream®, MetroLotion®)
- Finacea® foam
|
Drugs that will have a higher copayment on the Preferred Drug List
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.
Drugs that will have a higher copayment |
Common use or
drug class |
Preferred alternatives |
Nulev® |
Gastrointestinal conditions |
Generic hyoscyamine sulfate 0.125mg, 0.375mg tablet (Such as Levsin®, Levbid®) |
Sucraid® |
Congenital sucrase-isomaltase deficiency |
Discuss treatment options with your provider. |
Xywav® |
Narcolepsy, Idiopathic hypersomnia |
Discuss treatment options with your provider. |
Zomig® 2.5mg nasal spray |
Migraine |
- Generic triptan (such as sumatriptan nasal spray (Imitrex®)
- Zolmitriptan 5mg nasal spray (Zomig®)
- Orally disintegrating tablet (Zomig ZMT®)
- Rizatriptan orally disintegrating tablet (Maxalt-ODT®)
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Brand-name drugs with a generic copay that won’t be covered on the Preferred Drug List
On some of our drug lists, select brand-name drugs are covered at a generic copay and the generic equivalent drug isn’t covered. These brand-name drugs will no longer be covered at the generic copay. Members can fill prescriptions with the generic equivalent, and the brand-name drug will no longer be covered.
Brand-name drug |
Covered generic equivalent |
Adderall® XR |
Dextroamphetamine/ amphetamine ER capsule |
Advair® Diskus® |
Fluticasone propionate/salmeterol Diskus, Wixela® Inhub® |
Firazyr® |
Icatibant acetate injection |
Lialda® |
Mesalamine 1.2 g tablet |
Targretin® capsule |
Bexarotene capsule |
Targretin® gel |
Bexarotene gel |
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