BlueChoice HealthPlan Pharmacy Changes Update

BlueChoice HealthPlan continually evaluates their prescription drug formularies and drug management programs to ensure effective management of quality and costs. They work with a group of independent doctors and pharmacists to assess their pharmacy programs and get recommendations.

Based on the group's feedback, BlueChoice® will make changes to their prescription drug coverage and utilization management program for large groups and CarolinaADVANTAGE legacy small groups. Members negatively impacted by one of these changes will be sent a letter in November.

Formulary Additions
These drugs will be added to the formulary effective January 1, 2022.

Bold indicates a specialty drug. * Requires Prior Authorization | # Quantity Limit

Formulary Exclusions
The following drugs will continue as nonformulary. All products listed have alternatives available on the formulary, many times at a lower cost to the member. Some covered alternatives may require prior authorization.

• Abecma
• Accrufer
• Aduhelm
• Azstarys

• Evkeeza
• Nextstellis
• Qelbree
• Zegalogue

These drugs will move to nonformulary status, effective January 1, 2022:

• Acuvail
• Bepreve
• butalbital-APAP-caffeine cap
• Colchicine cap 0.6 mg
• diclofenac sodium-misoprostol tab 75-0.2 mg
• doxycycline hyclate tab 200 mg DR
• doxycycline hyclate tab 50 mg
• Equetro

• Fenofibric cap 135 mg DR
• Ilevro
• Invokamet
• Invokamet XR
• Invokana
• Lastacaft
• Nevanac
• Pazeo
• Venlafaxine tab ER

Tier Changes
Effective January 1, 2022, the drug Pancreaze will move to Tier 4.

Prior Authorization Updates
Effective January 1, 2022, the following drugs will require prior authorization:

• Osphena
• Pancreaze
• Pertzye
• Restasis
• Viokace

Step Therapy Program Updates
Effective January 1, 2022, the following product will have a step therapy requirement:

The carrier is also sending this communication to their large groups and CarolinaADVANTAGE legacy small groups, except for any groups using the Premium formulary.