BIRMINGHAM, AL – Effective Jan. 1, 2019, Blue Cross Blue Shield of Alabama will no longer cover OxyContin for members with the exception of Blue Advantage members. This is in response to concerns for members’ care and safety.
Since 2015, opioid prescriptions in the U.S. and in Alabama have declined. Over the last two years, opioid prescriptions for BCBS Alabama’s commercial members have decreased 18 percent. While progress is being made, this issue calls for continued action by all parties.
Beginning Jan. 1, 2019, the following changes to Blue Cross’ Opioid Management Strategy for commercial members will be implemented:
- Roxybond, the new instant release oxycodone formulation that is considered “abuse deterrent” by the FDA, will be covered.
- Lucemyra (lofexidine), the first non-opioid approved drug to treat the symptoms of opioid withdrawal, will be covered.
- OxyContin, and its generic (oxycodone ER), will no longer be covered. Xtampza ER (oxycodone ER) will be available to all members at a non-preferred brand cost share.
Letters have been mailed to members receiving OxyContin or oxycodone ER notifying them of the change and recommending that they follow up with their doctor to discuss potential alternatives. Providers have also been notified with a list of covered alternatives.
Several alternatives will be covered at the lowest copay for members who need a long-acting opioid for around the clock pain management: Morphine ER, Tramadol ER, Fentanyl ER and Methadone will be covered.
Blue Cross always encourages its members to consult their doctors about any treatments or prescription drugs they may need, and the company relies on physicians’ expertise to know what is best for their patients. Blue Cross will continue to develop and adopt actionable policies and procedures that promote safe prescribing of opioid medication and appropriate access to treatment for opioid use disorder. In addition, we will continue to collaborate with Alabama physicians and pharmacists to help curb the growing epidemic of opioid misuse by offering support, resources, and educational tools to network providers. This, combined with our strategies to improve access to medications used to treat substance abuse and drug overdoses, demonstrate our commitment to the health of our membership.
While some Blue Cross and Blue Shield customers in Alabama will no longer be able to use CVS for their prescription drugs, the Medical Association members who have PIPA policies will not be affected.
CVS is no longer in the Blue Cross and Blue Shield Alabama preferred network for certain plans, and according to the company, the change will affect some 13 percent (about 390,000), of the 2.69 million Blue Cross customers in Alabama. The change was made through the insurer and its pharmacy benefit manager, Prime Therapeutics.
Blue Cross spokeswoman Koko Mackin said the change was made to help offset the continuous rise in prescription drug costs and provide customers with the best price.
CVS has responded to the change noting that it was not the company’s “desire or decision” to be excluded from any pharmacy network.
“CVS Pharmacy continues to accept all commercial plans offered by BCBS Alabama, which are typically through large employers and other groups of over 50 participants,” said Gary Serby, Director of Corporate Communications for CVS. “CVS Pharmacy also continues to accept all BCBS Alabama Medicare Part D plans.”
The change does not affect Medicare members who have drug coverage through Blue Cross. The Medical Association’s PIPA policyholders are also unaffected by the change.
The Physicians Insurance Plan of Alabama through Blue Cross Blue Shield is available for qualified members of the Medical Association providing you, your family and staff with strong benefits at affordable premiums as compared to other options. Let our dedicated staff provide you with one-on-one personal assistance with all your Blue Cross and Blue Shield of Alabama policy needs.
“We’ve all seen the media reports of as much as a 40 percent increases in premiums through the federal insurance exchanges,” said Association Executive Director Mark Jackson. “However 2017 PIPA rates for health and dental coverage will have only a minimum increase with no change in benefits. Your membership dues alone could save you thousands in insurance premiums and out-of-pocket expenses.”
Qualified members may sign up for insurance when full Regular Member dues are paid. The PIPA plan does not require that all participants in your office be on the same plan.
Jackson added that working closely with Blue Cross and Blue Shield of Alabama kept PIPA premiums at a minimum increase across all benefit plans. The 2017 rates are now available online at www.alamedical.org/insurance.
Not all participants in a practice be enrolled in the same plan/option. There will be no change in benefits, and there will be no increase in co-pays, deductibles or out of pocket expenses. There are also no benefit changes with our dental plan. The Medical Association continues to provide a strong and rich medical and dental plan for its membership.
If you are currently enrolled in the PIPA insurance program, you do not need to re-apply for 2017. If you or your employees wish to make changes to your current plan, please do so before Oct. 31, 2016, (the last day of Open Enrollment). Changes made during Open Enrollment will take effect Jan. 1, 2017. You should receive your First Quarter 2017 premium invoice by the first week of December. Please contact Brenda Green with questions at (334) 954-2514 or toll free at (800) 239-6272.