Consistent with our management practice, April 1, 2019 is the next scheduled update of the BCBSRI Commercial formulary. This update includes all commercial fully insured, self-insured, and small group segments. This update does not include Medicare programs or individual markets.
Effective April 1, 2019 we will update coverage for oral contraceptives consistent with Affordable Care Act (ACA) guidelines
We have completed a review of all available oral contraceptives to evaluate compliance with ACA guidelines, which require the inclusion of all available methods of birth control and provides for a $0 out-of-pocket cost for members. Our evaluation confirmed that we are meeting requirements. However, we also identified that our formulary coverage exceeded ACA access requirements, specifically for oral contraceptives. Our review identified that the monthly cost/Rx for similar products within each therapeutic category (e.g., Monophasic, Tri-Phasic, Extended cycle) ranged from $20 to $300. As a result, we will implement a coverage update that will remove many high-cost oral contraceptives (within each specific category) from the ACA eligible $0 coverage list, while maintaining access and compliance with ACA standards. In addition, one product (Taytulla) will be removed from the formulary because it has many lower cost alternatives.
To be clear, this update will simply remove products from the eligible ACA $0 coverage list, but they will remain covered on the formulary, typically at a generic copay tier. Members are not required to make any change in their prescription(s); however, they will begin to pay a copay for the targeted products unless they choose to transition to a similar product that continues to be included on the ACA $0 coverage list.
Member notifications were distributed before February 1, 2019 to provide adequate advance notice of the update effective April 1, 2019.
Overview: A total of 1,410 members across the Commercial market segments received a targeted notification letter.
Formulary exclusion (This was sent to 39 members.)
TAYTULLA
A separate update will be provided at a later date for all other formulary changes to be implemented for April 1, 2019.