Blue Cross and Blue Shield of Kansas City (Blue KC) recently announced its plan to issue prescription drug list (PDL) changes on July 1 and January 1 of each year in an effort to help consumers manage rising drug costs.
On July 1, 2017, Blue KC will be making changes to its prescription drug list.
For a summary of the upcoming changes and additional details, click below.
- Specialty Pharmacy: Members must obtain specialty medications from Blue KC’s designated specialty pharmacy, Accredo. If a pharmacy other than Accredo is used, the member will be responsible for the full cost of the medication. Additional specialty drugs will require prior authorization.
- Step Therapy: Step-therapy programs will be added to additional drug classes. Members must try a proven, lower-cost medication prior to taking a more costly treatment.
- Administration of Infusion Medications: In cases where infusion medications can be safely administered outside of a hospital setting, Blue KC will now require select treatments to be administered at a lower-cost care site such as in the home, physician’s office, or infusion clinic. An exception would be if a hospital outpatient facility accepts a comparable rate to the alternative care sites.
Affected members and prescribing physicians will be notified by letter in May to ensure they are informed of the details and updates.
For questions, contact your Bukaty benefits consultant at 913.345.0440.
