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For Release December 2010

Blue Cross and Blue Shield of Alabama’s Pharmacy and Therapeutics (P & T) Committee recently approved updates
to the Prescription Drug Guide and made clinical program changes to select medications. All information is
accessible online at www.bcbsal.com.The P & T Committee consisting of doctors, pharmacists, nurses, and other
healthcare professionals advises and makes recommendations based on clinical and cost-effective outcome reviews.
Preferred Glucose Meters and Test Strips – Effective January 1, 2011

Effective January 1, 2011, Bayer products (i.e., Ascensia Contour and Breeze 2) will move to a preferred status, along
with Roche products (i.e., Accu-Chek). Lifescan products (i.e., One Touch) will move to a non-preferred status, along
with all other products in this category. All members who currently use a Lifescan product will receive a letter with
instructions on to obtain a preferred meter.
Prescription Drug Guide Updates – Effective January 1, 2011
The following drugs may have changes that affect what a member will be required to pay at the time of purchase. All
members that are negatively affected by a formulary change that is not a result of a generic being available will receive
a letter.
BRAND NAME (generic name if available)
Description of Change
Move from Tier 2 to Tier 3, generics available Move from Tier 2 to Tier 3, generics available Move from Tier 2 to Tier 3, generics available For a complete listing of generic and preferred brand alternatives, please refer to the Prescription Drug Guide located in the Pharmacy section of the Blue Cross and Blue Shield of Alabama website at the address below: www.bcbsal.org/pharmacy/index.cfm
Clinical Program Updates – Effective January 1, 2011

The following medication dispensing limits (DL), prior authorization (PA), and/or step therapy (ST) programs have been
added or revised:

New or Revised PA or ST Programs
Policy Name
Target Drugs
Coverage Criteria Changes
NEW – ST program requires use of at least one
generic ACEI or ARB prior to use of Preferred Brand ARBs (Diovan/HCT, Exforge/HCT, Micardis/HCT), and requires use of at least one Preferred Brand ARB prior to use of a Non-Preferred Brand ARB or Renin * Members with a claim for the requested brand ARB or Renin Inhibitor within the past 90 days will not be Tekamlo Tekturna/HCT Teveten/HCT Tribenzor Twynsta Valturna NEW – ST program requires use of at least one
generic Statin prior to use of a branded Statin. * Members with a claim for the requested brand Statin within the past 90 days will not be subject to step REVISED – Members must have a diagnosis of chronic
idiopathic constipation or irritable bowel syndrome with
constipation with documentation of symptoms for ≥3
months. Members must try at least two alternative
laxative treatments prior to coverage of Amitiza.
REVISED – Addition of Staxyn to PA/QL program.
Under standard benefits, Staxyn will require PA for men <50 years of age and will have a QL of 8 tablets REVISED – PA program will now require use of the
preferred product Pegasys prior to use of non-preferred PegIntron for all new starts. REVISED – Addition of generic omeprazole-sodium
bicarbonate as target for ST program. ST program will require use of generic lansoprazole or omeprazole prior omeprazole-
to use of generic omeprazole-sodium bicarbonate or sod bicarb
any other target PPI. QL of 1 tablet per day will apply. pantoprazole Prevacid Prilosec Protonix Zegerid REVISED – Addition of Epiduo and Veltin to PA
program which under standard benefits requires PA for Differin
Epiduo
Retin-A
tretinoin
Tretin-X
Tazorac
Veltin
Ziana

New Dispensing Limits
Brand (Generic) Name
Strength
Dispensing Limit per Month
* If strengths are not specifically listed, quantity limits apply to all available strengths.

Note: Coverage is subject to each member’s specific benefits. Group specific policies will supersede these policies
when applicable. Please refer to the member’s benefit plans.
For complete details, pharmacy policies may be viewed on the Blue Cross and Blue Shield of Alabama website at the
address below:
www.bcbsal.org/providers/pharmPolicies/final.cfm 

Source: http://www.hudsonalpha.org/sites/default/files/pdf/bcbs_pharmacy.pdf

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