Drug Management

Many of our prescription drug plans include Drug Management programs that promote quality, safety and proper use of certain medications. We base the Drug Management programs on U.S. Food and Drug Administration and manufacturer guidelines, medical literature, safety, accepted medical practice, appropriate use and benefit design. 

  • Prior Authorization – Drugs in this program require prior approval before the plan will cover them. View our Prior Authorization Drug List
  • Quantity Management – This program limits the amount we cover for certain drugs. We provide medical necessity exceptions for some of these limits when you request and receive prior authorization for them. View our Quantity Management Drug List.
  • Step Therapy – Step Therapy requires members to try cost-effective “First Choice” medications before trying (or “stepping up to”) more expensive “Second Choice” medications. We provide medical necessity exceptions when you request and receive prior authorization for them. View our Step Therapy Drug List.

Medical Necessity Exception Requests for Prior Authorization and Step Therapy

To request prior authorization or an exception for a medical necessity, please find the appropriate fax form for non-specialty drugs

You can find prior authorization fax forms for specialty drugs on the Accredo website. (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.

 


 

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