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September 2018
Drug exclusions will take effect Oct. 1, 2018
Our goal at Blue Cross Blue Shield of Michigan and Blue Care Network is to provide our members with safe, high-quality prescription drug therapies. We continuously review prescription drugs to provide the best value for our members, control costs and make sure our members are using the right medication for the right situation.
We’ve made some changes to the drugs we cover as detailed below:
Acne drugs
We’ll stop covering the acne drugs listed below, and their generic equivalents, because there are safe, effective and less-expensive choices available.
Product |
Drugs not covered as of Oct. 1 |
Average cost of drugs not covered as of Oct. 1 |
Covered
alternatives |
Average cost of covered alternatives |
|
Topical |
Evoclin® |
$572 per package |
Cleocin T® |
$22 to $115 per package |
Retin-A® Micro® |
$500 to $950 per package |
Atralin®
Avita®
Retin-A® |
$110 to $200 per package |
Veltin®, Ziana® |
$763 to $906 per package |
Cleocin T® |
$22 to $115 per package |
Atralin®
Avita®
Retin-A® |
$110 to $200 per package |
Oral |
Absorica® |
$42 per capsule |
Claravis™ Myorisan® Zenatane® |
$7.50 per capsule |
Acticlate® |
$32 per tablet |
Avidoxy®Monodox®Vibramycin® |
$0.20 to $0.90 per tablet or capsule |
Solodyn® |
$47 to $49 per tablet |
Minocin® |
$0.03 to $2.50 per tablet or capsule |
Migraine and pain drugs
We’ll stop covering the various drugs listed below, and their generic equivalents, because there are safe, effective and less-expensive choices available.
Drugs not covered as of Oct. 1 |
Average cost per unit |
Common uses |
Covered alternatives |
Average cost per unit |
Cambia® |
$83 |
Migraine |
Ecotrin® |
$0.03 |
Voltaren® |
$0.09 |
Motrin® |
$0.05 |
Anaprox®, Naprosyn® |
$0.23 |
Relpax® |
$15.25 |
Imitrex® |
$0.70 |
Maxalt®, MLT® |
$1.35 |
Zomig®, ZMT® |
$9.75 |
Drugs not covered as of Oct. 1 |
Average cost per unit |
Common uses |
Covered alternatives |
Average cost per unit |
Naprelan® |
$15 to $28 |
Pain |
Cataflam®; Voltaren®, ER® |
$0.53 |
Lodine® |
$0.95 |
Motrin® |
$0.04 |
Toradol® |
$1.25 |
Mobic® |
$0.03 |
Relafen® |
$0.26 |
Anaprox®, Naprosyn® |
$0.06 to $1.35 |
Clinoril® |
$0.19 |
Cough and cold drugs not approved by the FDA
We’ll also stop covering the cough and cold drugs listed below for members under the age of 18. These contain codeine or hydrocodone and haven’t been approved by the U.S. Food and Drug Administration for use in members under the age of 18.
Generic drug |
Example brand name |
Codeine/brompheniramine/pseudoephedrine |
M-End® PE, Poly-Tussin®AC |
Codeine/chlorpheniramine |
Tuzistra® XR |
Codeine/chlorpheniramine/pseudoephedrine |
Capcof® |
Codeine/guaifenesin |
Cheratussin® AC, G Tussin® AC, Guaiatussin® AC, Guaifenesin AC, Virtussin AC |
Codeine/dexchlorpheniramine/phenylephrine |
Pro-Red® AC |
Codeine/phenylephrine/promethazine |
Promethazine® VC w/codeine |
Codeine/phenylephrine/triprolidine |
Histex® AC |
Codeine/pseudoephedrine/guaifenesin |
Cheratussin® DAC, Guaifenesin® DAC, Virtussin® DAC |
Hydrocodone/chlorpheniramine |
Tussionex® |
Hydrocodone/chlorpheniramine/pseudoephedrine |
Zutripro® |
Hydrocodone/guaifenesin |
Obredon® |
Hydrocodone/homatropine |
Hycodan®, Hydromet® |
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