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Important 2024 Blue Advantage and BlueRx Formulary Updates


Blue Advantage® and BlueRxSM have some important 2024 formulary updates for you to consider.

Insulin Coverage Change for 2024

Effective January 1, 2024, certain long-acting insulins covered on the Blue Advantage and BlueRx formularies will be updated as follows:

Plans     2023 Coverage 2024 Coverage
Blue Advantage
Complete and Premier  		 Lantus, Levemir, Tresiba, Toujeo  and Basaglar Lantus and Toujeo
BlueRx Enhanced and  Enhanced Plus Lantus, Levemir, Tresiba and  Toujeo Lantus and Toujeo
BlueRx Essential Lantus and Toujeo Lantus and Toujeo 
(no change)

 

Note: Novo Nordisk will discontinue its long-acting insulin Levemir in the U.S. in 2024.

  • Supply disruptions of Levemir FlexPen are expected in mid-January 2024.
  • Levemir FlexPen will be discontinued on April 1, 2024.
  • Levemir vial will be discontinued on December 31, 2024. 

Lantus and Toujeo are alternative covered long-acting insulins for the 2024 formulary.

Reference: https://www.mynovoinsulin.com/insulin-products/levemir/home.html 


If switching patients to a covered insulin (Lantus and Toujeo), use the chart below to help with this transition. These alternative options are on the 2023 Blue Advantage formularies so you can begin switching affected patients before 2024.

Switching from Basaglar (insulin glargine U-100)
To Lantus (insulin glargine U-100)
  • Convert unit-per-unit. Continue same dose and timing of administration.
To Toujeo (insulin glargine U-100)
  • Convert unit-per-unit and give once daily.
  • Expect that a higher daily dose (about 10% - 18%) of Toujeo will be needed to maintain control.
  • It may take > 5 days to see the maximum effect of the selected dose of Toujeo. Do not increase the Toujeo dose more often than every 3 to 4 days.
  • Do not mix insulin glargine with other insulins.
Switching from Levemir (insulin detemir)
To Lantus (insulin glargine U-100)
  • Consider converting unit-per-unit. A lower daily dose may be needed.
  • Give once daily or divided twice daily if necessary for control.
  • Do not mix insulin glargine with other insulins.
To Toujeo (insulin glargine U-100)
  • Levemir once daily: Convert unit-per-unit and give Toujeo once daily.
  • Levemir twice daily: Reduce total daily dose by 20% and give Toujeo once daily.
  • It may take > 5 days to see the maximum effect of the selected dose of Toujeo. Do not increase the Toujeo dose more often than every 3 to 4 days.
  • Do not mix insulin glargine with other insulins.
Switching from Tresiba (insulin degludec)
To Lantus (insulin glargine U-100)
  • If taking Tresiba < 80 units: Reduce dose by 20%.
  • If taking Tresiba > 80 units: Reduce dose by 20%, and the Lantus dose must be split into 2 equal doses given Q12H. 
To Toujeo (insulin glargine U-100)
  • Reduce dose by 20%.
Source: https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2016/Dec/How-to-Switch-Insulin-Products-10473

 

Alternatively, you can submit a formulary exception for each of your impacted patients to ensure their insulin regimen is not interrupted. Formulary exceptions for 2024 can be submitted starting November 1, 2023. Formulary exceptions can be submitted through Prime Therapeutics or CoverMyMeds.

Formulary exceptions require that a member must have tried and failed two formulary products or have clinical justification for not being able to use any of the formulary products in order to be approved. Formulary exceptions must be designated as a 2024 request. 

Pulmonary Agents Coverage Change for 2024

Effective January 1, 2024, all Blue Advantage and some BlueRx formularies will no longer include brand name pulmonary agent products Advair Diskus, Symbicort and Flovent HFA. Instead, the generic alternatives will be covered: fluticasone-salmeterol, budesonide-formoterol and fluticasone propionate hfa, respectively.

Pulmonary Agents
Plan     2023 Coverage 2024 Coverage
Blue Advantage
Complete and Premier		 Brand Name: 
  • Advair Diskus 
  • Flovent HFA
  • Symbicort  
 Generic: 
  • Fluticasone/Salmeterol,
  • Fluticasone Propionate hfa
  • Budesonide/Formoterol
BlueRx Enhanced 
and Enhanced Plus		 Brand Name:  
  • Advair Diskus
  • Flovent HFA
  • Symbicort    
 Generic: 
  • Fluticasone /Salmeterol
  • Fluticasone Propionate hfa
  • Budesonide/Formoterol
BlueRx Essential  Brand Name:  
  • Advair Diskus
  • Flovent HFA 
 Generic: 
  • Fluticasone /Salmeterol
  • Fluticasone Propionate hfa

 

Patients with a prescription for one of these inhalers will automatically be switched to the generic version at the point of sale, unless the original prescription indicates “dispense as written.” If the original prescription indicates “dispense as written,” a new prescription will be required to switch to the generic alternative. 

If a patient requires the brand name, providers can begin submitting a formulary exception request for 2024 starting on November 1, 2023.  Formulary exceptions can be submitted through Prime Therapeutics or CoverMyMeds.

Formulary exceptions require that a member must have tried and failed two formulary products or have clinical justification for not being able to use any of the formulary products in order to be approved. Formulary exceptions must be designated as a 2024 request. 


Blue Advantage® PPO and BlueRx (PDP) are provided by Blue Cross and Blue Shield of Alabama.
CoverMyMeds is available to Blue Cross and Blue Shield of Alabama through Prime Therapeutics, an independent company providing pharmacy benefit management services. CoverMyMeds is an independent company that provides electronic solutions for drug prior authorizations.