December 2019
Starting Jan. 1, we’ll change how we cover some drugs
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 continually review prescription drugs to provide the best value for our members, control costs and ensure members are using the right medication for the right condition.
Starting Jan. 1, 2020, we’ll change how we cover some brand-name and generic drugs. We’ll also set new quantity limits on certain drugs.
Note: Changes vary by drug list as specified below. For a complete list of 2020 covered drugs go to bcbsm.com/pharmacy. These changes apply to members with commercial pharmacy benefits (not Medicare D). They don’t apply to the Federal Employee Program®.
Drugs on Preferred Drug List that will have a higher copayment
The brand-name drugs that will have a higher copayment are listed below, along with the covered preferred alternatives that have similar effectiveness, quality and safety. The brand names of select covered alternatives are provided for your reference. When a prescription is filled, the generic equivalent is dispensed, if available.
Nonpreferred drugs |
Common use |
Covered preferred alternatives |
Absorica® |
Acne |
Amnesteem®, Claravis®, Myorisan®, Zenatane® |
Amitiza® |
Constipation |
Lactulose, Linzess®, Trulance® |
Arcapta Neohaler® |
Respiratory conditions |
Serevent Diskus® |
Atrovent HFA® |
Respiratory conditions |
Atrovent solution®, Incruse Ellipta® |
Byvalson® |
Heart conditions |
Bystolic® plus Diovan®, Tenormin® plus Diovan®, Toprol XL® plus Diovan® |
Fulphila® |
Hematopoietic agent |
Neulasta®, Udenyca® |
Gralise® |
Neuropathic pain |
Cymbalta®, Elavil®, Neurontin®, Tofranil®, Ultram® |
Hexalen® |
Chemotherapy |
Go to bcbsm.com for a complete list of covered alternatives. Members should discuss treatment options with their doctors. |
Moxeza® |
Antibiotic |
Ciloxan® drops, Garamycin®, Tobrex® drops, Vigamox® |
Relenza® |
Influenza |
Tamiflu® |
Sancuso® |
Nausea and vomiting |
Emend® capsules, Kytril®, Zofran® |
Tabloid® |
Chemotherapy |
Go to bcbsm.com for a complete list of covered alternatives. Members should discuss treatment options with their doctors. |
Xofluza® |
Influenza |
Tamiflu® |
Zontivity® |
Heart conditions |
Aspirin plus Plavix®, Effient® |
Drugs on Preferred Drug List that won’t be covered
The brand-name and generic drugs that won’t be covered are listed below, along with the covered preferred alternatives that have similar effectiveness, quality and safety. Unless noted, both the brand name and available generic equivalents won’t be covered. The brand names of select covered alternatives are provided for your reference. When a prescription is filled, the generic equivalent is dispensed, if available.
Excluded drugs |
Common use |
Covered preferred alternatives |
Akynzeo® |
Nausea and vomiting |
Emend® capsules, Kytril®, Varubi® tablets, Zofran® |
Altabax® |
Skin conditions |
Bactroban® ointment, gentamicin cream, ointment |
Amrix® |
Muscle relaxants |
Flexeril®, Norflex®, Parafon Forte DSC® 500 mg, Robaxin®, Zanaflex® |
Aubagio® |
Multiple sclerosis |
Gilenya®, Mayzent®, Tecfidera® |
Bactroban® cream |
Skin conditions |
Bactroban® ointment, gentamicin cream, ointment |
Conzip®, tramadol extended-release biphasic capsules |
Pain (opioid) |
Ryzolt®, Ultram® |
Denavir® |
Skin conditions |
Generic oral antivirals (Famvir®, Valtrex®, Zovirax®), Zovirax® ointment |
Diabetes meters and test strips |
Diabetes |
Freestyle and OneTouch meters and test strips |
Doral® |
Insomnia |
Ambien®, Ambien® CR, Lunesta®, Restoril®, Sonata® |
Emend® powder packets for suspension |
Nausea and vomiting |
Emend® capsules, Kytril®, Varubi® tablets, Zofran® |
Epaned® |
Heart conditions |
Vasotec® |
Fibricor® |
High cholesterol |
Lofibra®, Tricor®, Trilipix® |
Firdapse® |
Lambert-Eaton myasthenic syndrome |
Ruzurgi® |
Generic Kristalose® |
Constipation |
Lactulose |
Granix® |
Hematopoietic agent |
Nivestym®, Zarxio® |
Indocin® suspension |
Pain (non-steroidal anti-inflammatory) |
Generic NSAID (such as Feldene®, Indocin® capsule, Lodine®, Mobic®, Motrin®, Naprosyn®, Voltaren®) |
Jadenu®, Sprinkle |
Chelating agent |
Desferal® |
Lorzone® |
Muscle relaxants |
Flexeril®, Norflex®, Parafon Forte DSC® 500 mg, Robaxin®, Zanaflex® |
Mulpleta® |
Thrombocytopenia |
Doptelet® |
Onzetra Xsail® |
Migraines |
Amerge®, Frova®, Imitrex®, Imitrex® nasal spray, Maxalt® |
Orfadin® |
Hereditary tyrosinemia
type 1 |
Nityr® |
Pandel® |
Skin conditions |
Diprosone® lotion, Elocon® cream, lotion, solution, Kenalog® ointment and spray, Synalar® ointment, Westcort® ointment |
Pennsaid® 2% |
Pain (NSAID) |
Flector® patches, Pennsaid® 1.5% |
Qbrelis® |
Heart conditions |
Prinivil® |
Sitavig® |
Antiviral |
Famvir®, Valtrex®, Zovirax® |
Striverdi Respimat® |
Respiratory conditions |
Serevent Diskus® |
Subsys® |
Pain (opioid) |
Actiq®, Dilaudid®, morphine sulfate IR, oxycodone IR |
Tivorbex® |
Pain (NSAID) |
Generic NSAID (such as Feldene®, Indocin® capsule, Lodine®, Mobic®, Motrin®, Naprosyn®, Voltaren®) |
Tudorza® |
Respiratory conditions |
Incruse Ellipta® |
Vivlodex® |
Pain (NSAID) |
Generic NSAID (such as Feldene®, Indocin® capsule, Lodine®, Mobic®, Motrin®, Naprosyn®, Voltaren®) |
Xatmep® |
Immunosuppressant |
Methotrexate tablet |
Xerese® |
Skin conditions |
Generic oral antivirals (Famvir®, Valtrex®, Zovirax®), Zovirax® ointment |
Zipsor® |
Pain (NSAID) |
Generic NSAID (such as Feldene®, Indocin® capsule, Lodine®, Mobic®, Motrin®, Naprosyn®, Voltaren®) |
Zovirax® cream |
Skin conditions |
Generic oral antivirals (Famvir®, Valtrex®, Zovirax®), Zovirax® ointment |
Drugs on Clinical and Custom Drug Lists that will have a higher copayment
The brand-name drugs that will have a higher copayment are listed below along with the covered preferred alternatives that have similar effectiveness, quality and safety. The brand names of select covered alternatives are provided for your reference. When a prescription is filled, the generic equivalent is dispensed, if available.
Nonpreferred drugs |
Common use |
Covered preferred alternatives |
Alocril® |
Allergies |
Alrex®, Bepreve®, Elestat®, Opticrom®, Optivar®, Pataday®, Patanol®, Pazeo® |
Alomide® |
Allergies |
Alrex®, Bepreve®, Elestat®, Opticrom®, Optivar®, Pataday®, Patanol®, Pazeo® |
Granix® |
Hematopoietic agent |
Nivestym®, Zarxio® |
Neupogen® |
Hematopoietic agent |
Nivestym®, Zarxio® |
Drugs on Clinical and Custom Drug Lists that won’t be covered
The brand-name and generic drugs that won’t be covered are listed below, along with the covered preferred alternatives that have similar effectiveness, quality and safety. Unless noted, both the brand name and available generic equivalents won’t be covered. The brand names of select covered alternatives are provided for your reference. When a prescription is filled, the generic equivalent is dispensed, if available.
Excluded drugs |
Common use |
Covered preferred alternatives |
Aerospan® |
Respiratory conditions |
Arnuity Ellipta®, Asmanex® HFA, Flovent® HFA, Diskus, Pulmicort Flexhaler®, Pulmicort solution®, Qvar RediHaler® |
Altabax® |
Skin conditions |
Bactroban® ointment, gentamicin cream, ointment |
Amrix® |
Muscle relaxants |
Flexeril®, Norflex®, Parafon Forte DSC® 500 mg, Robaxin®, Zanaflex® |
Aplenzin® |
Mood disorders |
Wellbutrin®, Wellbutrin® SR, Wellbutrin® XL |
Bactroban cream® |
Skin conditions |
Bactroban® ointment, gentamicin cream, ointment |
Conzip®, tramadol extended-release biphasic capsules |
Pain (opioid) |
Ryzolt®, Ultram® |
Denavir® |
Skin conditions |
Zovirax® ointment |
Doral® |
Insomnia |
Ambien®, Ambien® CR, Lunesta®, Restoril®, Sonata® |
Fibricor® |
High cholesterol |
Lofibra®, Tricor®, Trilipix® |
Forfivo® and bupropion XL 450mg tablet |
Mood disorders |
Wellbutrin®, Wellbutrin® SR, Wellbutrin® XL |
Indocin® suspension |
Pain (NSAID) |
Generic NSAID (such as Feldene®, Indocin® capsule, Lodine®, Mobic®, Motrin®, Naprosyn®, Voltaren®) |
Kristalose® |
Constipation |
Lactulose |
Lazanda® |
Pain (opioid) |
Actiq®, Dilaudid®, morphine sulfate IR, oxycodone IR |
Lorzone® |
Muscle relaxants |
Flexeril®, Norflex®, Parafon Forte DSC® 500 mg, Robaxin®, Zanaflex® |
Nascobal® |
Vitamins |
Cyanocobalamin injection (vitamin B-12) |
Pandel® |
Skin conditions |
Diprosone® lotion, Elocon® cream, lotion and solution, Kenalog® ointment, spray, Synalar® ointment, Westcort® ointment |
Xerese® |
Skin conditions |
Generic oral antivirals (Famvir®, Valtrex®, Zovirax®), Zovirax® ointment |
Zovirax® cream |
Skin conditions |
Generic oral antivirals (Famvir®, Valtrex®, Zovirax®), Zovirax® ointment |
Drugs on Custom Select Drug List that will have a higher copayment
The brand-name drugs that will have a higher copayment are listed below, along with the covered preferred alternatives that have similar effectiveness, quality and safety. The brand names of select covered alternatives are provided for your reference. When a prescription is filled, the generic equivalent is dispensed, if available.
Nonpreferred drugs |
Common use |
Covered preferred alternatives |
Alocril® |
Allergies |
Alrex®, Bepreve®, Elestat®, Opticrom®, Optivar®, Pataday®, Patanol®, Pazeo® |
Alomide® |
Allergies |
Alrex®, Bepreve®, Elestat®, Opticrom®, Optivar®, Pataday®, Patanol®, Pazeo® |
Drugs on Custom Select Drug List that won’t be covered The brand-name and generic drugs that won’t be covered are listed below along with the covered preferred alternatives that have similar effectiveness, quality and safety. Unless noted, both the brand name and available generic equivalents won’t be covered. The brand names of select covered alternatives are provided for your reference. When a prescription is filled, the generic equivalent is dispensed, if available.
Excluded drugs |
Common use |
Covered preferred alternatives |
Aerospan® |
Respiratory conditions |
Arnuity Ellipta®, Asmanex® HFA, Flovent® HFA, Diskus, Pulmicort Flexhaler®, Pulmicort solution®, Qvar RediHaler® |
Brand Harvoni® |
Hepatitis |
Epclusa®, Zepatier® |
Chorionic gonadotropin® |
Infertility |
Pregnyl® |
Exalgo® |
Pain (opioid) |
Butrans®, Duragesic®, methadone, MS Contin®, Opana ER®, Ultram ER® |
Fibricor® |
High cholesterol |
Lofibra®, Tricor®, Trilipix® |
Granix® |
Hematopoietic agent |
Nivestym®, Zarxio® |
Indocin® suspension |
Pain (NSAID) |
Generic NSAID (such as Feldene®, Indocin® capsule, Lodine®, Mobic®, Motrin®, Naprosyn®, Voltaren®) |
Neupogen® |
Hematopoietic agent |
Nivestym®, Zarxio® |
Novarel® |
Infertility |
Pregnyl® |
Quantity limits The drugs below will have changes to the amount that can be filled. These changes apply to all drug lists.
Drug |
Quantity limit as of Jan. 1, 2020 |
Lyrica® capsules (all strengths) |
3 capsules daily |
EpiPen®, Epipen® Jr.,
epinephrine auto- injector, Symjepi® |
4 pens per fill, maximum of 8 pens per year |
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