Florida Blue Pharmacy Prescription Updates
Florida Blue Members,
Each year on Jan. 1 and July 1, Florida Blue Pharmacy updates its prescription lists. Medications are added, removed, placed in a step program, have quantities limited, are excluded from coverage, or now require prior authorization to be filled. Those affected should have received correspondence about the change.
Please review the MedGuide Blue Options July2023 document to see if any of the changes affect your current or future prescriptions so you will not have any issues with your medication. Some of the changes are:
Drugs Added to the Responsible Quantity Program
Brand/Generic Name Dispensing Limit Per Month (unless noted otherwise):
- Acetaminophen-codeine 120mg-12mg/5mL oral soln 2700 mL
- Amjevita 2 syringes or pens/28 days
- Atorvaliq 20 mg/5 mL 600 mL
- Austedo XR 6 mg, 12 mg 30 tabs
- Austedo XR 24 mg 60 tabs
- Bismuth subcitrate potassium-metronidazoletetracycline 120 caps / 90 days
- Daybue 200 mg/ml 8 bottles
- Dexlansoprazole DR 30 mg 30 caps
- Doxepin HCl 5% cream 45 grams
- Erleada 240 mg 30 tabs
- Filspari 30 tabs
- Gefitinib 250 mg 30 tabs
- Gralise 450 mg, 750 mg 30 tabs
- Gralise 900 mg 60 tabs
- Jaypirca 50 mg 30 tabs
- Jaypirca 100 mg 60 tabs
- Joenja 60 tabs
- Kalydeco 13.4 mg packet 56 packets/28 days
- Konvomep 40 mg/20mL suspension 600 mL
- Lumakras 320 mg 90 tabs
- Lumryz 30 packets Lurasidone 20 mg, 40 mg, 60 mg, 120 mg 30 tabs
- Lurasidone 80 mg 60 tabs
- Lyrica CR 82.5 mg, 165 mg 30 tabs
- Lyrica CR 330 mg 60 tabs
- Omnipod GO 10 kits
- Orenitram titration kit 1 kit/180 days
- Orserdu 86 mg 90 tabs
- Orserdu 345 mg 30 tabs
- Oxybutynin 2.5 mg tab 90 tabs
- Oxybutynin 5 mg/5ml 600 mL
- Pradaxa 20 mg, 150 mg 60 packets
- Pradaxa 30 mg, 40 mg, 50 mg, 110 mg 120 packets
- Skyclarys 50 mg 90 caps
- Takhzyro 150 mg/ml 2 syringes/28 days
- Teriflunomide 30 tabs
- Topiramate ER 24 hr 200 mg 60 caps
- Trikafta 56 packets/28 days
- Udenyca auto-injector 2 pens/28 days
Responsible Steps Program Changes
The following changes apply to the Responsible Steps Program.
Program/Program Change
- Atorvaliq suspension added as a target
- Dexlansoprozole DR added as a target
- Konvomep suspension added as a target
New Pharmacy Coverage Exclusions
Commercial pharmacy plans will no longer cover the brand-name or generic drugs listed below. Florida Blue will cover many of their therapeutic or generic alternatives. This exclusion list applies only to members enrolled in health plans that allow pharmacy coverage exclusions.
New Coverage Exclusions
- Auvelity Relexxii/Methylphenidate 45 mg, 63 mg
- Amjevita 40 mg/0.8 ml Tascenso ODT 0.25 mg, 0.5 mg
- Bystolic brand Veralan PM 100 mg, 200 mg, 300 mg
- Ezetimibe/Atorvastatin
- Viibryd brand
- Javygtor
- Xelstrym
- Latuda brand
- Zoniside
- Minocyline ER 105 mg, 135 mg
Medications Requiring Prior Authorization
Prior authorization requirements for the following list of medications will change under the member’s pharmacy benefits. This applies only to members whose plans are part of the Prior Authorization Program. New-to-market drugs may still be under review for a coverage decision as a part of Florida Blue’s New-to-Market Program.
Drugs Added to the Prior Authorization Program Drug Covered Condition(s)
- Altuviiio FDA approved indication(s)*
- Amjevita FDA approved indication(s)
- Austedo XR FDA approved indication(s)
- Daybue FDA approved indication(s)
- Filspari FDA approved indication (s)
- Jaypirca FDA approved indication(s)
- Joenja FDA approved indication(s)
- Oserdu FDA approved indication(s)
- Skyclarys FDA approved indication(s)
