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Changes to Coverage of Oral-Combined Contraceptives Due to Wide Range of Generic Alternatives

May 15, 2018

Applies to: All commercial market segments (excludes commercial plans utilizing the NetResults Formulary and public sector groups)

Horizon Blue Cross Blue Shield of New Jersey manages pharmacy benefits to encourage the safe and appropriate use of prescription medicines. We are changing the way that we provide coverage for brand name, oral-combined contraceptive pills.

Starting June 15, 2018, brand name, oral-combined contraceptive pills will no longer be covered at a $0 copayment. This change is due to the wide range of generic alternatives that are available in various dosage forms and strengths for contraception. These brand name contraceptives will continue to be covered under a member’s pharmacy benefit, but a corresponding copayment or coinsurance amount will apply based on the member’s pharmacy plan design.

Below are examples of commonly prescribed brand name, oral-combined contraceptive pills that will have the appropriate copayment or coinsurance applied to them:

Examples of brand name, oral-combined contraceptive pills:

  • Estrostep Fe
  • Lo Loestrin Fe
  • Loestrin 1/20-21
  • Loestrin Fe 1.5/30
  • Loestrin Fe 1/20
  • LoSeasonique
  • Minastrin 24 Fe
  • Mircette
  • Ortho Micronor
  • Ortho Tri-Cyclen
  • Ortho Tri-Cyclen Lo
  • Ortho-Cyclen
  • Ortho-Novum 1/35
  • Ortho-Novum 7/7/7
  • Seasonique
  • Taytulla
  • Tri-Norinyl 28
  • Yasmin 28
  • Yaz

Horizon BCBSNJ will continue to cover generic, oral-combined contraceptive pills at a $0 copayment.

If a health care professional feels the brand name, oral-combined contraceptive pills are medically necessary for their patient(s) at zero cost share rather than the generic alternatives, a Copay Waiver form may be submitted for clinical review.

Impacted members and their prescribers will receive a letter notifying them about this change prior to the June 15, 2018 effective date.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

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Published on: May 22, 2018, 03:45 AM ET
Last updated on: May 22, 2018, 05:06 AM ET