Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Pharmacy topic
No spam. Unsubscribe anytime.
Trustees press staff on access to Ozempic/Maijar-style drugs; BCBS reports ~370 members on GL medications
Summary
Board members sought clarity on step‑therapy and prior‑authorization for GL class drugs such as Ozempic and Manjaro. BCBS said members already approved retain access; new starts require clinical review. The carrier reported about 370 district members taking those medications.
Trustees asked how the district’s self‑funded plan would handle GL‑class drugs and whether the district could pursue local direct primary contracting. Blue Cross representative Tita Ilueguez and consultant Sean Cope explained that the plan uses BCBS’s negotiated network discounts and that step‑therapy/prior authorization applies to new patients.
Tita said members who were preapproved when the contract started remain on those medications, but new starts must supply medical and clinical lab information for Prime to review. She told the board: “Those that they really needed, they had already…we already preapproved…Because it was approved 09/01/2024.”
Trustees pressed for utilization data and a breakdown of how many employees use specific drugs; staff agreed to supply that detail. At the meeting BCBS reported an approximate count: “currently, we have approximately 370 members that they are taking on Sempic and Majar.” Trustees said they want percentage breakdowns of drug usage across roughly 3,000 employees to guide vendor selection and benefit design.
