📌 Note | Beginning 5/1/2024 BCNC will be covering A1c test kits and BP cuffs for members under our Enhanced and Essential formularies .
See information below about methods to identify which members are covered under the Enhanced and Essential formularies.
Prescription Coverage Details
A prescription is required for coverage (see attached files to access prescription request forms)
HTN Prescription Request Provider Communication
DM Prescription Request Provider Communication
Covered NDCs are included in the attached file BCBS NC Covered NDCs
The day supply must be entered as 30 days.
Quantity limits (QL)
A1c tests will have a QL of 2 tests per 180 days
BP cuffs will have a QL of 1 cuff per 365 days.
Patient Eligibility Details
You can determine if a member is covered by one of the formularies by looking in the bottom, right corner of their Blue Cross NC ID card.
If a member is covered by one of the Enhanced or Essential formularies, the circled area on the example ID card above corresponds to column one of the table below.
ID Card Codes | Plan Description | Plan Shorthand |
N/A or Exclude | Exclude | E |
Rx A2 or 2A | Enhanced 4 Tier Commercial Broad Network | Enhanced 4 Tier C |
Rx B2 or 2B | Enhanced 5 Tier Commercial Broad Network | Enhanced 5 Tier C |
Rx A4 or 4A | Enhanced 4 Tier Commercial Limited NC Network | Enhanced 4 Tier C |
Rx B4 or 4B | Enhanced 5 Tier Commercial Limited NC Network | Enhanced 5 Tier C |
Rx C4 of 4C | Essential Commercial Limited NC Network | Essential C |
Rx C2 or 2C | Essential Commercial Broad Network | Essential C |
Rx D4 or 4D | Essential QHP Limited NC Network | Essential Q |
Rx D2 or 2D | Essential QHP Broad Network | Essential Q |
Rx E4 or 4E | NetResults 5 Tier Commercial Limited NC Network | NetResults 5 Tier C |
Rx A5 or 5A | Enhanced 4 Tier Commercial, Limited National Network | Enhanced 4 Tier C |
Rx B5 or 5B | Enhanced 5 Tier Commercial Limited National Network | Enhanced 5 Tier C |
Rx C5 or 5C | Essential Commercial, Limited National Network | Essential C |
Rx E5 or 5E | NetResults 5 Tier Commercial Limited National Network | NetResults 5 Tier C |
Rx A3 or 3A | Enhanced 4 Tier C Broad Plus Network | Enhanced 4 Tier C |
Rx B3 or 3B | Enhanced 5 Tier C Broad Plus Network | Enhanced 5 Tier C |
Rx C3 or 3C | Essential Commercial Broad Plus Network | Essential C |
Rx E3 or 3E | NetResults 5 Tier C Broad Plus Network | NetResults 5 Tier C |
Rx F4 or 4F | Essential QS | Limited NC Network Essential QS |