News from the Blues

May 8, 2024

GLP-1 New to Therapy Optional Benefit Program Now Available for ASO
Applies to large, national and ASO groups

As of April 1, 2024, we are offering a new optional pharmacy benefit program, GLP-1 New to Therapy, to help ASO large (151+) groups with Prime Therapeutics^® address the rising utilization of GLP-1 drugs. Groups can implement this benefit option for GLP-1 drugs that are indicated for Diabetes Only use, drugs that are indicated for Weight Loss Only use, or for both Diabetes and Weight Loss.

How it works: GLP-1 New to Therapy limits an initial fill(s) to 30 days when members are new to GLP-1 drug therapy. New to therapy is defined as members who do not have claims history for a GLP-1 medication within the past 120 days. After the initial fill(s), members may be eligible for up to a 90-day supply, per their pharmacy benefits.

Note: a 30-day supply limit may continue to apply after the first fill if the member moves to a new dosing strength or changes to a different GLP-1 medication.

• These modifications are often costly and can contribute to drug waste.
• Limiting initial fills can also help members utilize the medication as intended based on FDA labeling as they find their right dosage.

Next Steps: There is a 60-day implementation lead time for this program, offered at no additional cost to you. If interested, please reach out to your Blue Cross and Blue Shield of Texas account representative or Prime account team to learn more.

Blue Cross and Blue Shield of Texas contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.com  is an online resource offered by Prime Therapeutics.