Capital BlueCross: Formulary and Utilization Management Program Updates

Decisions from recent P&T Committee meetings (May 2015 and August 2015) resulted in updates to their commercial line of business (does not include Medicare) made to the open/closed and selectively closed formulary.

Updates include:

  •  Newly Marketed Drugs
  •  Products Changing Tier Status
  •  Pharmacy Utilization Management Programs

Formulary updates are communicated via BenefitFOCUS, Simply-Well, and the Provider Administrative Bulletin.

Quarterly Formulary Update and Decision Summaries by Quarter for the open/closed formulary and the selectively closed formulary can also be found on Capital BlueCross Pharmacy Information page

 

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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.