2015 to 2016 Medicare Part D Formulary Changes

Dec. 31, 2015

Blue Cross Medicare Advantage (HMO)SM/Blue Cross Medicare Advantage (PPO)SM

Based on CMS mandates (i.e. safety concerns, drugs that no longer meet the CMS definition of a "Part D medication," etc.) and a regular review of changes in the pharmaceutical marketplace, Blue Cross Medicare Advantage 2016 Part D plans will have formulary and utilization management changes for 2016.

Members were alerted of these changes in late November 2015 via targeted mailings as well as in the Annual Notice of Change (ANOC) sent to all current members with Blue Cross Medicare Advantage Medicare Part D plans.

Visit the Pharmacy Program/Medicare Part D Updates section of our website for a quick reference that includes the "Top 30" medications impacted by these formulary changes. For the full 2016 formulary, please refer to the website.

Members are instructed to ask their doctor about the medications they are prescribed, and if any of these formulary, quantity limit or prior authorization changes may impact them, to have a prescription written for a formulary alternative. If the alternative is not appropriate for your patient, please start a coverage determination for the medication needed. Forms are available on the website.


Blue Cross Medicare Advantage plans are HMO and PPO plans provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC's plan depends on contract renewal.

The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member's certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.