To continue providing our members and their health care providers with access to a wide variety of safe, clinically effective medications at affordable prices, we will be making changes to our pharmacy program, effective January 1, 2011.

Who Will Be Affected?
The January 1, 2011 pharmacy program changes will apply to the following plans:

• Commercial plans with pharmacy benefits
• Medex^® plans with the optional three-tier pharmacy benefit

Health care providers have already been advised of these changes. Our affected members will be notified directly no later than December 1, 2010.

What Changes Will Be Made?
For January 1, 2011, we will be making important changes to:

• Non-Covered Medication Status
• Medication Tier Status
• Over-the-Counter Benefit Exclusions
• Quality Care Dosing Limits
• Step Therapy Policy
• Pharmacy Medical Policies
• Prior Authorization
• Retail Specialty Pharmacy Network

Medications Changing to Non-Covered Status
After careful clinical consideration and a cost evaluation of each drug's covered alternatives, as of January 1, 2011, the following medications will no longer be covered:

When medically necessary, a health care provider may request an exception to have these non-covered medications covered.

1. The medication's non-covered status also applies within the BlueValue Rx^SM formulary.

Medications Changing Tier Status
When we determine that a medication offers more or less value, both clinically and financially, in comparison to alternative medications in its class, we change the medication's tier status. Depending on the indicated tier change, as of January 1, 2011, members may be required to pay more or less for these medications.

Effective January 1, 2011, the medications below will belong to the following tier levels:

2. The medication's tier status also applies within the BlueValue Rx formulary.

Medications Changing to an Over-the-Counter Benefit Exclusion
When medications no longer require a prescription and become available over-the-counter, or when medications have an over-the-counter equivalent, we discontinue benefits for those medications. This is known as "over-the-counter benefit exclusion." As of January 1, 2011, the following medications will be considered benefit exclusions:

• meclizine 12.5mg tablet
• clotrimazole 1% cream and solution
• Dologesic caps (APAP/phenyltoloxamine)
• hydrocortisone 0.5% cream
• hydrocortisone 1% lotion

These benefit changes apply to both our standard and BlueValue Rx formularies. health care provider requests for coverage exceptions will no longer be approved for the above medications.

New Quality Care Dosing Limits
In order to help monitor medication quantity and dosage for our members, we will be making changes to our Quality Care Dosing efforts. New dosing limitations will apply to the medications below in both our standard and BlueValue Rx formularies, beginning January 1, 2011:

Please refer to the Quality Care Dosing section on Member Central for both the dose and limits that apply for each medication.

New Step Therapy Policy
To assist health care providers with appropriate and affordable drug treatments, we require step therapy for certain courses of medication. As of January 1, 2011, we will require the use of Byetta (Step 1) before the use of Victoza (Step 2). These medications are commonly used in the treatment of Type 2 Diabetes in adults.

Pharmacy Medical Policy Updates
As more information becomes available regarding medically necessary technologies, procedures, and treatments, we may revise some of our pharmacy medical policies. Beginning January 1, 2011, the following policy updates will be effective for both our standard and BlueValue Rx formularies:

• Retirement of Policy 021 (Orphan Drugs for the Treatment of Rare Disease) and Policy 022 (Antifungal Therapy)
• Addition of new Policy 246 (Ampyra; dalfampridine)
• Revisions made to Policies 262 (Aranesp, Epogen and Procrit), 024 (Antidepressants), 011 (Asthma), 169 (Migraines), 030 (Proton Pump Inhibitors), and 013 (Antihyperlipidemics)

To review the most up-to-date policy information, please visit our online library of Medical Policies.

Prior Authorization for Medications Administered Using the Medical Benefit
For members enrolled in our HMO, POS, and Access Blue plans, prior authorization is required under the member's medical benefit for certain medications that are administered in a physician's office, hospital outpatient setting, or by a home infusion therapy provider. Effective January 1, 2011, this requirement will also apply to the following medications.

• Dysport (injectable)
• IIaris
• Simponi
• Stelara

The prior authorization requirements may already apply to these medications when members fill provider prescriptions at retail pharmacies.

Retail Specialty Pharmacy Network Update
Blue Cross Blue Shield of Massachusetts will welcome Accredo^® to our designated retail specialty pharmacy network, beginning January 1, 2011. As an established and well-known specialty pharmacy, Accredo will provide our members with another trusted option for obtaining their specialty medications.

Online Tool Offers Convenience for Health Care Providers
Last October, we introduced ExpressPA, a web-based tool that allows providers to submit prior authorization and formulary exception requests electronically. This applies to any prescription medication that is processed as part of the Express Scripts pharmacy benefit. The tool is available 24/7, and gives providers instant answers to their inquiries, which results in requests for our members being facilitated more quickly and efficiently. To date, more than 950 providers are using the tool, and over 5,000 requests have been submitted.

For more information about the January 1, 2011 pharmacy program changes, please contact your account executive.