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Changes to Our Pharmacy Program

Changes to Our Pharmacy Program

Beginning September 1, 2017, we're making changes to our covered medications list that will affect:

  • Medications switching tiers
  • Medications that are no longer covered
  • One medication moving to benefit exclusion (also impacts Managed Blue for Seniors)

Plans affected by the changes:

  • Commercial medical plans with pharmacy benefits
  • Medex®' plans with the three-tier pharmacy benefit

Medications Changing Tier Status
When the cost of a medication changes, we move the medication to a different tier. Depending on the tier change, members may be required to pay more or less for the following medications:

Medication Class Medication Name Covered Tier Level as of September 1, 2017 under a 3 Tier Formulary Covered Tier Level as of September 1, 2017 under a 4 Tier Formulary
Proton Pump Inhibitors (PPI) Esomeprazole
Omeprazole Omeprazole/BiCarb
Prevacid SoluTab
Tier 3 Tier 4
Syringes Terumo Thinpro Ulticare Tier 2 Tier 3

Note: Members using combination prescription medications to treat H. pylori will continue to pay their current cost.

Medications No Longer Covered
After carefully reviewing each medication's cost and covered alternatives, we've removed the medications listed in the chart below from our covered medications list for the plans referenced above. However, when these medications are medically necessary, a member's doctor or prescriber may request a coverage exception.

Medication Class Non-Covered Medication or Supply
Angiotensin II Receptor Blockers (for high blood pressure) Azor, Benicar, Benicar HCT, and Tribenzor
Antipsychotic Medications Seroquel XR
Asthma/Allergy Treatment Singulair
Cholesterol-Lowering Medications Zetia
Colonoscopy Preparation/ Laxatives Osmoprep*
Dermatological Treatments Alcortin-A, Anusol HC Suppository, Lidocaine-HC 2%-2.5% Kit, Relador Pak, Relador Pak Plus, Salicylic Acid 6% Lotion Kit

*Since Osmoprep is a one-time use medication, we will not issue member letters.

Medication Excluded from Pharmacy Coverage
The following medication will be excluded from our pharmacy coverage because it's cosmetic. This change will apply to all commercial plans, group Medex®' plans with pharmacy benefits, and Managed Blue for Seniors. Formulary exception will not be accepted for this medication.

Medication Name
Avenova Lid-Lash Spray
Blue Cross Blue Shield of Massachusetts

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