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As a healthcare provider, you understand the importance of helping patients choose cost-effective generic statin medications for managing high cholesterol. When a patient has a goal of lowering LDL by less than 40%, a generic statin should be considered before a brand medication. For a goal of lowering LDL by 40% or more, a brand medication such as Lipitor may be necessary.
It is important for you to know that Lipitor will become available as a generic on November 30, 2011. At that time, brand cholesterol medications will cost patients more and we have communicated this to our members so they can discuss their options with their Network Provider.
To ensure the most cost-effective and medically necessary medication for cholesterol management, Blue Cross & Blue Shield of Mississippi will require a prior authorization for all new high-dosage Crestor (20mg and 40 mg) prescriptions. Please read the information below regarding the questions and clinical criteria that will be required in the assessment of the high-dose Crestor prior authorization process.
- Does the patient require a percentage LDL reduction goal of greater than 40%? If so, please be prepared to enter the percentage LDL reduction goal, provide medical documentation of the patient’s current LDL and the diet and exercise treatment plan that will supplement the prescribing of high-dose Crestor.
- Does the patient require a percentage LDL reduction goal of less than 40%? If so, please be prepared to provide the following information:
- Medical documentation of patient’s current LDL.
- Medical documentation indicating failure of previous generic statin, Lipitor, Crestor (5mg or 10mg) or another brand name statin medication.
- Medical documentation showing failure of LDL reduction goals based on previous usage of medications listed above. Medical documentation will need to include:
- Patient's initial LDL
- Treatment therapy used to treat initial LDL, including diet and exercise
- Duration of the treatment therapy to assess results
- Side effects encountered while using previously prescribed medications
- Diet and exercise treatment plan that will supplement the high-dose Crestor prescription
Network Providers may complete the Crestor Prior Authorization process electronically via myAccessBlue. Your electronic prior authorization request and corresponding clinical documentation will be sent directly to Blue Cross & Blue Shield of Mississippi. Once you have submitted your request, you will be able to track its status via myAccessBlue.
Non-Network Providers can select the Prescription Drug Prior Authorization page here.
For questions regarding the new online Crestor Prior Authorization requirement, please contact our Prescription Drug Service Team at 601-664-4998 or 1-800-551-5258.