Upcoming Pharmacy Program Updates - Effective October 1, 2023

Upcoming CareFirst Formulary Updates Effective October 1, 2023

CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) strives to provide affordable, accessible care to our members. We know that any increases in pharmacy spending have the potential to be transferred to our subscribers in the form of higher healthcare costs or offset by lower payments to our valued provider partners. To prevent unnecessary increases, we conduct a quarterly review of our formularies and make changes to encourage utilization of safe and clinically cost-effective drugs.

A summary of changes effective October 1, 2023 is available for your review.

These updates apply to your patients with CareFirst prescription benefits. Formulary updates may include drug additions, utilization management changes, changes to drug tiers and/or removal of medications.

Having strong safeguards in place to manage pharmacy spending also benefits providers in value-based contracting arrangements.

Medications Added to Prior Authorization and Site of Care Management Lists—Effective October 1, 2023

Effective October 1, 2023, the medications listed in the full article will be added to the list of drugs subject to prior authorization and site of care management to better manage rising specialty drug costs. These medications are covered under the medical benefit and are administered in the outpatient hospital, home or office settings.

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