Applies to: Group Markets
Learn about the revisions to the drug list for members with prescription drug benefits administered by Prime Therapeutics®.
Drug List Changes
Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some revisions and/or exclusions will be made to the Blue Cross and Blue Shield of Illinois (BCBSIL) drug lists, effective July 1, 2019. Changes by drug list are listed on the chart links below.
- Revisions include drugs still covered but moved to a higher out-of-pocket payment level.
- Exclusions are drugs no longer covered.
Note: The drug list changes listed below do not apply to BCBSIL members on the Basic Annual, Multi-Tier Basic Annual, Enhanced Annual, Multi-Tier Enhanced Annual, Performance Annual or Performance Select Annual Drug Lists. These drug lists will have the revisions and/or exclusions applied on or after Jan. 1, 2020.
BCBSIL HMO Illinois® or Blue Advantage HMOSM members will not have any of these drug list revisions/exclusions applied to their pharmacy benefits until Jan. 1, 2020.
Review Drug List Updates (Revisions/Exclusions) – Effective July 1, 2019 
Review Drug List Updates (Coverage Additions/Coverage Tier Changes) – Effective April 1, 2019
Dispensing Limit Changes
BCBSIL’s prescription drug benefit program includes coverage limits on certain medications and drug categories. Dispensing limits are based on FDA-approved dosage regimens and product labeling. Changes by drug list are listed on the chart link below. Note: The dispensing limits listed below do not apply to BCBSIL members on the Basic Annual or Enhanced Annual drug lists. Dispensing limits will be applied to these drug lists on or after Jan. 1, 2020.
Review Dispensing Limit Changes – Effective July 1, 2019
Standard Utilization Management Program Package Changes
Step Therapy (ST) Program Changes
- Effective July 1, 2019, the Ophthalmic Prostaglandins ST program will change its name to: Glaucoma. The program, which applies to the Basic and Enhanced drug lists only, includes the same targeted medications and a new one, Rhopressa. The program criteria remain the same.
Prior Authorization (PA) Program Changes
Several drug categories and/or targeted medications will be added to the PA programs for standard pharmacy benefit plans upon renewal for non-ASO groups. This includes ASO groups that have selected auto updates. For groups that have not selected auto updates, these programs will be available for selection as of the program effective date. Contact your BCBSIL representative for more information.
Please Note: As a reminder, the PA and ST programs for standard pharmacy benefit plans correlate to a member’s drug list. Not all standard PA and ST programs may apply, based on the member’s current drug list. A list of PA and ST programs per drug list is posted on the member prescription drug plan information section of bcbsil.com.
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Drug Category
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Targeted Medication(s)
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Basic, Enhanced, Balanced, Performance, Performance Select Drug Lists
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Alternative Dosage Form†
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Carafate suspension, Naprosyn suspension
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Topical Lidocaine†
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Pliaglis, Synera
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Basic, Enhanced Drug Lists
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Arikayce
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Arikayce
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Fabry Disease
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Galafold
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hATTR Amyloidosis Neuropathy
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Tegsedi
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Hyperhidrosis
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Qbrexza
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Orilissa
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Orilissa
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†Applies to BCBSIL Performance Annual drug list
- Effective July 1, 2019, the Arikayce PA program and target drug Arikayce will also be added to the Balanced, Performance, Performance Annual and Performance Select drug lists.
- Effective July 1, 2019, the Firdapse PA program will be added to the Balanced and Performance Select drug lists. This program includes the target drug Firdapse.
- Effective July 1, 2019, the hATTR Amyloidosis Neuropathy PA program and target drug Tegsedi will also be added to the Balanced, Performance, Performance Annual and Performance Select drug lists.
- Effective July 1, 2019, the Neurotrophic Keratitis PA program will be added to the Balanced, Performance, Performance Annual and Performance Select drug lists. This program includes the target drug Oxervate.
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Drug Category
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Targeted Medication(s)
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Basic, Enhanced, Balanced, Performance and Performance Select Drug Lists
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Nocturia†
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Nocdurna
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Basic, Enhanced and Performance Drug Lists
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Therapeutic Alternatives†
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Dutoprol, Kenalog spray
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Basic and Enhanced Drug Lists
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Antifungal Agents
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Tolsura
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- Effective July 1, 2019, the Antifungal Agents program update will also apply to the Balanced, Performance, Performance Annual and Performance Select drug lists.
Targeted mailings were sent to members affected by drug list revisions and/or exclusions, prior authorization program and dispensing limit changes per our usual process of notifying members prior to the effective date.
View the most up-to-date drug list and list of drug dispensing limits on bcbsil.com.
Reminder: Select Group Prescription Drug Lists’ Update Frequency Changed April 1, 2019
As a reminder and previously communicated, most of the prescription drug lists that were once updated annually on January 1, or at the group’s renewal date, have moved to a quarterly update. For groups on these affected drug lists, the frequency change is being implemented upon the group’s renewal/effective date starting on or after April 1, 2019. This update frequency change includes the Enhanced, Multi-Tier Basic and Multi-Tier Enhanced drug lists.
Note: Fully insured HMO groups will remain on an annual update.
Note: For those drug lists that remain on an annual update, or until a plan has moved to a quarterly update (where applicable), the drug list name has been changed to include “Annual” in the title. Both the quarterly updated and annually updated drug lists are posted on bcbsil.com.
If you have any questions regarding these changes, contact your BCBSIL representative.