The Blue Cross and Blue Shield of Kansas City (Blue KC) Medical and Pharmacy Management Committee has reviewed the Prescription Drug Lists (PDLs) and other pharmacy programs for drug safety, effectiveness, clinical outcomes, and cost.
As a result, ACA small employer groups, non-ACA small employer groups ( including level funded ASO) large employer groups, and ACA individual and family plan members will see the following formulary updates, effective January 1, 2023.
Employer/group PDL updates
ACA small employer groups
ACA small employer groups will have routine updates to the Essential Health Benefits PDL.
Non-ACA small employer groups (2-99), including level funded ASO
Non-ACA small employer groups, including level funded ASO, will have routine updates to the Premium PDL.
Large employer groups (100+)
- Preferred PDL: Large employer groups on the Preferred PDL will have routine updates to the Preferred PDL.
- Premium PDL: Large employer groups on the Premium PDL will have routine updates to the Premium PDL.
Communications to groups
- Impacted large employer groups will receive an email next week
- Impacted small employer groups will receive a letter that will mail this week
- Impacted members will receive a letter by December 1
Individual and family plan PDL updates
Members enrolled in an ACA individual and family plan will have routine updates to the Essential Health Benefits PDL. Members will receive a letter notifying them of the PDL changes.