Individual customers: New 2015 prior authorization requirements for high dose narcotics on the Select Drug Program formulary

Good morning.  Independence Blue Cross has provided us with the following alert about new requirements for specific high dose narcotics on the Select Drug Program Formulary.  Please review the information below.  

Effective January 1, 2015, certain prescription medications (high dose narcotics) from our Select Drug Program^® formulary required prior authorization.^* Due to the unique nature of these medications, impact to existing users has been delayed to allow patients with active prescriptions time to discuss their options with their health care provider. Therefore up until now, the only members affected by this requirement were those with prescriptions starting after January 1, 2015.

Now, we are in the process of alerting affected members and their healthcare providers of the prior authorization requirement as it takes effect.

Which medications are affected by this change?
The following brand and generic medications are affected by this change:

Which members were affected by this change?
Approximately 60% of the members affected by this change are individual customers. Primary agents and producing agents with group customers affected by the change were previously notified by their Independence Blue Cross account executive.

How are we communicating this change to members?
We will be sending a letter to affected members to advise them of the change. The letter will list the medication(s) the member currently takes that will require prior authorization and specify the options for continuing therapy. The letter will be sent to members at least 30 days in advance of the date their prior authorization requirement takes effect.

Letters will be sent according to the following schedule:

Mailing dates for members whose authorization ends on 3/31/15:

• January 26
• February 2 and 16

Mailing dates for members whose authorization ends on 6/30/15:

• March 2, 16, and 30
• April 13 and 27
• May 11 and 25

How are we communicating this change to healthcare providers?
We will be sending a letter to providers who have patients affected by this change. It will include a list of affected patients and the medication(s) that will require prior authorization.

The letters will be sent out on the following dates:

To providers with members whose authorization ends on 3/31/15:

• January 26

To providers with members whose authorization ends on 6/30/15:

• March 2
• April 13

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