Blue Cross Blue Shield Medication Prior Authorization Form Process Explained

Understanding the Blue Cross Blue Shield medication prior authorization form process can be a daunting task, but don't worry, I'm here to break it down for you.

First, you'll need to determine if your medication requires prior authorization. According to Blue Cross Blue Shield, medications that require a step therapy or quantity limit are subject to prior authorization.

To start the process, you'll need to fill out the prior authorization form, which can be obtained from your pharmacy or online through the Blue Cross Blue Shield website.

The authorization process for Blue Cross Blue Shield medication prior authorization forms can be a bit confusing, but it's essential to understand the steps involved.

To start, you'll need to submit a prior authorization request form, which can be found on the Blue Shield of California plan members' website or the Blue Shield Promise members' website. The form is available in PDF format.

The form is divided into two main sections: one for healthcare professional-administered drug requests and another for servicing provider change requests. You can download the form for each section separately.

Prior authorization lists are also available on the Blue Shield of California plan members' website or the Blue Shield Promise members' website. These lists indicate the medical services and procedures that require medical necessity review and/or supplemental documentation before payment is made.

To ensure that clinically appropriate quality of care is provided, Blue Cross Blue Shield requires prior authorization for certain services, including interventional spine management services and spine surgeries. However, a prior authorization is not required in emergency care situations.

Here's a summary of the services that require prior authorization:

By following these steps and understanding the prior authorization process, you can ensure that your medication requests are approved and that you receive the necessary care.

Prior authorization (PA) and step therapy (ST) programs are in place to encourage safe and cost-effective medication use. These programs are developed by a team of physicians and pharmacists who review FDA-approved labeling, scientific literature, and nationally recognized guidelines.

Physicians must complete and submit a request form for all PA and ST medications, and benefits will apply if the member meets specified criteria. If criteria are not met, the member may still choose to receive the medication, but will be responsible for the full cost.

Prime Therapeutics, the pharmacy benefit manager for Blue Cross and Blue Shield of Oklahoma, conducts all reviews of PA and ST requests from physicians.

Authorization lists are an essential part of navigating healthcare coverage. You can view the list of medical services and procedures requiring medical necessity review and/or supplemental documentation before payment is made.

For Blue Shield of California plan members, the list is available online. Similarly, for Blue Shield Promise members, you can access the list to understand what services may require prior authorization.

Prior authorization lists can be lengthy, so it's a good idea to check the specific requirements for your plan.

Prior authorization and step therapy programs are in place to encourage safe and cost-effective medication use. These programs require physicians to complete and submit a request form for certain medications, and benefits will apply if the member meets specified criteria.

Prime Therapeutics, the pharmacy benefit manager, conducts all reviews of prior authorization and step therapy requests for Blue Cross and Blue Shield of Oklahoma members with prescription drug coverage.

Physicians must complete a request form for all prior authorization and step therapy medications, and the final decision regarding what medicines should be prescribed is a decision between the patient and their physician.

Not all prescription drug benefit plans include prior authorization and step therapy programs, and the drug categories may vary depending on the member's plan.

CoverMyMeds is a registered trademark of CoverMyMeds LLC, an independent third party vendor that provides products and services for prior authorization and step therapy requests.

BCBSOK contracts with Prime Therapeutics LLC to provide pharmacy benefit management, prescription home delivery, and specialty pharmacy services.

The pharmacy criteria is not intended to influence treatment decisions, and providers are expected to make treatment decisions based on their medical judgment.