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2014 Insulin Coverage Update

November 08, 2013

At BlueCross BlueShield of South Carolina, we continue to look for ways to keep medical and pharmacy benefits affordable for your patients who are our members. With approval from our Pharmacy and Therapeutics Committee, made up of local physicians and pharmacists, we have made a key change in the insulin product coverage for 2014.

Starting in January 2014, we will add Apidra, Humalog and Humulin insulins (except U-500) to our prior authorization program. they will move to tier 3/Non-preferred. Novolin and Novolog will remain tier 2/Preferred drugs and will not require prior authorization. Please note that basal insulins will also remain at tier 2.

Here's How This Change Will Affect Your Patients with BlueCross Coverage

  • Those who have a prior authorization benefit as part of their plans will no longer have coverage for Apidra, Humalog or Humulin insulins unless you request a prior authorization and it is approved. Please note, you will not need to provide documentation of medical necessity for continued use of these non-preferred insulins.
  • Members who are granted prior authorization for Apidra, Humalog or Humulin will pay the highest copayment under their plans.

Your Next Steps

  • Speak with your patients about their new covered preferred medication options, Novolin or Novolog, and how this change may affect them if they continue to use their current insulin.
  • Write of phone in a new prescription for one of the preferred alternative medications, if one of those is a good choice for your patient.

If necessary, you can initiate a prior authorization by calling Caremark toll free at 800-294-5979. Caremark is an independent company that assists in the administration of pharmacy benefits on behalf of BlueCross for all of our insured members and many of our self-funded members.

We appreciate your willingness to review and consider this information. If you have questions about this prescription drug update, please send an email to Provider.Education@BCBSSC.com.



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