Important Changes to Your Formulary

Open/Closed (Group Coverage) Including Updates Effective August 1, 2018

Capital BlueCross typically updates our formulary on a quarterly basis. We make changes when new drugs are added to or removed from the market. Drugs are evaluated based on safety, efficacy and cost.

An independent panel of doctors, nurses, and other experts choose the drugs in our formulary.

Find a full list of recent updates.

Below are changes that may need special attention:

Drugs for Erectile Dysfunction

The following drugs require Prior Authorization (PAR). This means that your prescription needs authorization before it can be filled. If they do not receive authorization, they will not be covered. To request authorization, call 800.294.5979.

  • Caverject*
  • Edex*
  • Levitra*
  • Muse*
  • Staxyn*
  • Stendra*
  • Viagra*

The following drug changed status from brand preferred to brand non-preferred. This means that if you have an open formulary, your cost-share may increase. If you have a closed formulary, the drug will no longer be covered.

  • Levitra*

The following drug requires Enhanced Prior Authorization (EPA). Also known as Step Therapy, this means that to get your prescription, you must either complete a first-line (alternative) drug and/or prior authorization. Specific instructions are outlines below:

  • Cialis 2.5mg/5mg*
    • If you are 18 or older and using Cialis for symptomatic benign prostatic hyperplasia (BPH) with or without erectile dysfunction, you must first complete a 30-day prescription of one of the below medications.
      • An alpha-blocker (e.g., alfuzosin, doxazosin, silodosin, tamsulosin, or terazosin)
      • A 5-alpha-reductase inhibitor (5-ARI (e.g., dutasteride, finasteride 5 mg))
      • A combination alpha-blocker and 5-ARI (e.g., Jalyn (dutasteride/tamsulosin))
    • If you are 18 or older and using Cialis for erectile dysfunction, you must first receive prior authorization by calling 800.294.5979.

Xyrem*

This drug, used to treat cataplexy and/or narcolepsy, has changed to a specialty-drug status. This means that it requires special handling. You can contact AllianceRx Walgreens Prime at 800.533.7606 to get started.

*Denotes brand drug

If you or your provider believe that coverage for any drug is medically necessary, you may appeal. Approvals are member- and drug-specific. Instructions for appealing are provided with your mailed denial notice.