Effective January 1, 2017, CMS will require Medicare plan sponsors to limit the daily cumulative dose of opioid products a member may obtain at Point of Sale (POS). The daily limit is referred to as the Morphine Equivalent Dose (MED) limit. The cumulative limit is based on a combination of drug strength and a product’s Morphine Milligram Equivalency (MME). The cumulative total daily MED value will be calculated based on the number of opioid drugs prescribed over a period of time which includes incoming claims and active claims history. Depending on the plan, there may be multiple MED limits with varying response levels (Soft or Hard reject).

*Please see attached PDF for more information.

Please note some Blue Cross and HMO Louisiana members will follow a new "closed" formulary, or Covered Drug List, effective January 1, 2017.

The new Covered Drug List (closed formulary) includes thousands of generic and brand drugs; however, not every drug will be covered. When a wide range of successful, lower-cost alternatives are available, higher-cost drugs may not be covered for members whose plans follow our new Covered Drug List. Members with this formulary have received a letter from Blue Cross Blue Shield of Louisiana (BCBSLA) explaining the change and where to find the list: www.bcbsla.com/CoveredDrugs. Members may also call the Pharmacy number on their ID card: 866.781.7533.

*Please see attached PDF for more information.

Dear Network Pharmacy Partner,

Please be advised that, effective 1/1/2017, MedImpact will be implementing new POS edit functionality to support mandatory 2017 CMS requirements for Medicare Part D claims processing.

*Please see attached PDF for more information.

*Please see attached PDF for more information.