Blue Cross Pharmacy Benefit Drugs: How to submit requests electronically

How to identify utilization management requirements for Blue Cross commercial

Identify Blue Cross 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 Medicare Plus Blue

To access the Medicare Plus Blue utilization management (step therapy or authorization requirements):

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 Medicare Plus Blue PPO 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 Medicare Plus Blue Group PPO plans.
2. Click the link to open the Prior Authorization and Step Therapy Program drug list.