Prescription Plans

Many of our prescription drug plans have drug management programs for medications* dispensed by pharmacies. We provide many of the prior authorization forms and exception request forms here.

Specialty Drugs

Visit the Accredo website for prior authorization fax forms for specialty drugs. (This link leads to a third party website. That company is solely responsible for the content and privacy policies on its site.) Accredo is an independent company that administers the specialty pharmacy program on behalf of BlueCross.

You can also call Care Continuum at 866-544-0857 or fax forms to 866-576-3869. Care Continuum is an independent company that processes specialty drug prior authorizations on behalf of BlueCross.

Non-Specialty Drug Prior Authorization Program

We require prior approval for drugs included in our prior authorization program for most members. To request prior authorization for non-specialty drugs, call Caremark's Prior Authorization department at 866-814-5506, or print the required prior authorization form and fax it to Caremark at 888-836-0730. Caremark is an independent company that assists in the administration of the program on behalf of BlueCross.

These are fax forms for drugs in our prior authorization program:

Adoxa   Advicor   Altoprev   Ambien   Ambien CR   Amitiza   Amnesteem   Anadrol-50   Androgel   Apidra

Atacand   Atacand HCT   Atralin   Avalide   Avapro   Avita   Beconase AQ   Breo Elipta   buprenorphine SL

Celebrex 400 mg   Claravis   Cozaar   Crestor   Detrol   Detrol LA   Differin   Diovan   Diovan HCT

Ditropan XL   Doryx   Dymista   Edarbi   Edarbyclor   Edular   Emend   Flonase   Fortamet   Forteo

FreeStyle Diabetic Test Strips   Glumetza   Gralise  Humalog   Humulin   Hyzaar   Intermezzo   JentaDueto

Kazano   Lamisil   Lescol   Lescol XL   Lipitor   Liptruzet   Livalo   Lumigan   Lunesta   Mevacor   Monodox

Mybetriq   Nasacort AQ   Nesina   Nuvigil   Oleptro   Olux-E   Omnaris   Oseni  Oxandrin   Oyxtrol  Pradaxa

Pravachol   Provigil   Qnasl   Rayos  Regranex   Retin-A   Rhinocort AQ   Riomet   Sanctura   Sanctura XR

Silenor  Sonata  Soriatane   Sotret   Sporanox   Suboxone   Subutex  Tekturna   Tekturna HCT   Testim

Teveten   Teveten HCT   Toviaz   Tradjenta  Tretin-X   Veramyst   Vytorin   Zenatane   Zetonna   Ziana   Zocor

Zolpimist  Zubsolv

Quantity Management Program

We limit the amount we cover for medications included in the quantity management program for many members. We cover higher quantities for some medications, when medical necessity is documented. 

Aciphex   Aloxi   Amerge   Anzemet   Avinza   Axert   butorphanol nasal spray   Celebrex   Dexilant   Duragesic

Embeda   Emend   Exalgo  Frova   Imitrex Injectable   Imitrex Oral   Kadian   Kytril   Maxalt   MS Contin   Nexium

Nexium-MtVernonMills   Opana   Oramorph   Oxycontin   Prevacid   Prilosec   Protonix   Relpax   Sancuso

Sumavel  Treximet   Zegerid   Zofran   Zomig   Zuplenz

Step Therapy Program

We require a generic or over-the-counter alternative trial before we cover medications included in the step therapy program for most members. We waive this requirement when medical necessity is documented.

Abilify   Aciphex   Amnesteem   Antara   Atralin   Avita   Claravis   Clarinex   Clarinex-D   Clozaril   Dexilant

Differin   Esomeprazole Strontium   Fabior   Fanapt   Fenoglide   Fibricor   First Omeprazole   Geodon   Invega

Khedezla  Latuda   Lipofen   Lofibra   omeprazole/bicarb   Prevacid   Prilosec   Pristiq   Protonix   Retin-A

Risperdal   Rozerem   Saphris   Seroquel   Solodyn   Sotret   Tazorac  Tretin-X   Tricor  Triglide   Trilipix

Uloric   Veltin    Versacloz   Xyzal   Zegerid   Ziana   Zyprexa

Prior Authorization Forms Request

Providers who need a prior authorization form that is not available online should call Caremark's Prior Authorization department. For non-specialty drugs, call 800-294-5979. You can also fax a form request to Caremark at 888-836-0730.

State Health Plan Prescription Drug Coverage

The State Health Plan provides prescription drug coverage through Catamaran. Catamaran is an independent company that contracts directly with the State Health Plan. Call Catamaran at 855-902-7322 or visit Catamaran's website (This link leads to a third party website. That company is solely responsible for the content and privacy policies on its site.)

 


*The medication names listed above may be the registered or unregistered trademarks of independent third-party pharmaceutical companies. These trademarks are included for informational purposes only and are not intended to imply or suggest any third-party affiliation.

Some links on this page lead to third party websites. Those parties are solely responsible for the contents and privacy policies on their sites.