The 2017 updates are results of the most recent Capital BlueCross Pharmacy & Therapeutics (P&T) Committee meetings, held in May 2016 and August 2016. These updates include January 1, 2017 changes to the open/closed and selectively closed formularies. Impacted members will be notified prior to changes.
These formulary updates reflect the decisions from quarterly P&T Committee meetings in the following categories (These updates do not apply to Medicare.):
- Newly Marketed Drugs
- Products Changing Tier Status
- Pharmacy Utilization Management Programs:
- Prior Authorization
- Enhanced Prior Authorization
- Quantity Level Limit
Effective January 1, 2017, the selectively closed formulary will consist of three tiers of medications: Generic, Brand Preferred, and Brand Nonpreferred. Currently, the selectively closed formulary operates as a two-tier generic formulary but will be changing to a one-tier generic formulary starting January 1, 2017.
Please note that the open/closed formulary will continue to operate with four tiers of medications: Generic Preferred, Generic Nonpreferred, Brand Preferred, and Brand Non-preferred.
Not all benefits utilizing the open/closed formulary have separate cost shares for generic drugs. For benefits that have one cost share for generic drugs, that cost share is applied to generic preferred and generic nonpreferred drugs. For generic specialty drugs, one cost share is applied to generic preferred and generic nonpreferred specialty drugs when applicable.
Formulary updates are communicated via BenefitFOCUS, Simply-Well, and the Provider Administrative Bulletin. Quarterly Formulary Update-Decision Summaries by Quarter for the open/closed formulary and the selectively closed formulary can also be found on the Capital’s Drug Formulary webpage