BCN Pharmacy Benefit Drugs: How to submit requests electronically

How to identify utilization management requirements for BCN commercial

Identify BCN commercial utilization management (step therapy or authorization) requirements by reviewing the following:

• Blue Cross PPO and BCN HMO prior authorization and step therapy coverage criteria
• Blue Cross PPO and BCN HMO prior authorization and step therapy coverage criteria for the Preferred Drug List

How to identify utilization management requirements for BCN Advantage

Identify BCN Advantage utilization management (step therapy or authorization) requirements by reviewing the following:

1. Visit the Medicare Drug Lists webpage and:
• For individual plans, scroll down to the heading "If you're buying your own insurance, use these drug lists." Click BCN Advantage HMO-POS and HMO plans.
• For group plans, scroll down to the heading "If you get your insurance through an employer, union or other group, use these drug lists." Click BCN Advantage Group HMO-POS and HMO plans.
2. Click the link to open the Prior Authorization and Step Therapy Program drug list.