BlueCross BlueShield of South Carolina

Medicare Advantage Following FDA Dose Limits

June 18, 2012

Beginning June 1, 2012, the BlueCross BlueShield of South Carolina Medicare Advantage claims system will reject prescriptions at the point of sale when patients seek medications prescribed above the U.S. Food & Drug Administration's (FDA’s) recommended maximum dose. Patients will only be allowed prescriptions filled according to the FDA recommendations, unless they have an approved exception.

To ensure the safety of our members, we have identified plan members who are being prescribed doses above the allowed maximum and have mailed letters to them explaining this change. We instructed them to give their physicians the letter and the quantity limit exception form. We ask that physicians give their prescriptions additional review and schedule an appointment with our member to discuss his/her medication therapy and the possibility of complying with the recommended dose.

The clinical staff of BlueCross Medicare Advantage understands that some patients require doses of medications above the FDA maximum allowed dose to treat their conditions effectively.  If physicians believe the patient’s condition is best treated with a dose above the maximum recommended dose, they can complete a quantity limit exception form and fax it to 855-633-7673, or call the appeals help desk at 800-294-5969. Physicians can also email us at medhelp@bcbssc.com for additional information.