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Change in EpiPen coverage

Starting January 10, 2017, EpiPen® is moving to non-Preferred status on Horizon Blue Cross Blue Shield of New Jersey’s commercial formularies. This means EpiPen will no longer be covered at the Preferred drug cost share and may cost affected commercial members more. This action is being taken in response to consumer demand and because a lower cost alternative, epinephrine auto-injector, the generic version of EpiPen containing the same active ingredients and made by the same manufacturer, is now available. More details are provided in letters beginning to mail on January 9, 2017.

Additionally, beginning March 1, 2017, Horizon BCBSNJ will apply our prior authorization process to EpiPen (for pharmacy benefit plans that have a prior authorization program). The criteria for coverage will require members try epinephrine auto-injector before receiving coverage for the branded EpiPen, unless there are specific medical circumstances that require the member use EpiPen. More information on this change will be available to affected members and their prescribing doctors in letters mailing in February.

For commercial members using EpiPen

If you or someone covered under your benefit plan continues getting EpiPen, it will continue to be covered under your pharmacy benefit. However, you may have to pay more out of pocket, depending on your pharmacy plan benefits. Talk with your doctor about switching to the new Preferred medicine. Preferred medicines could cost you less, but we understand treatment decisions are always between you and your doctor.

If you have other questions, we’re here to help 24 hours a day, seven days a week. Please call Pharmacy Member Services at 1-800-370-5088.

This page contains references to brand name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with Horizon Blue Cross Blue Shield of New Jersey, the Blue Cross Blue Shield Association or Prime Therapeutics LLC.

Published on: January 6, 2017, 16:09 p.m. ET
Last updated on: May 6, 2021, 04:03 a.m. ET