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Prior authorization requests are used to help ensure the most cost-effective and medically necessary medication is used to help our members. Requests are needed for a variety of medications. For some drugs, recently-released generics are a reason for prior authorization. For others, a specialized pharmacy, infusion center or medical specialist is needed to dispense or administer the drug.
Disease Specific Drugs treat certain chronic disease states such as rheumatoid arthritis, hepatitis, and multiple sclerosis. Disease Specific Drugs treat complex conditions, require special administration, monitoring, education, frequent dosage adjustments and have unusually high costs.
Prescription Drug benefits can vary depending on your patient's benefit plan. Members' financial responsibility may be either a co-payment or co-insurance amount. Members should refer to their Benefit Plan for their specific out-of-pocket expense responsibility.
All Disease Specific Drugs must be prescribed by a Network Provider, prior authorized by Blue Cross & Blue Shield of Mississippi, and dispensed by a Disease Specific Pharmacy or Non-Pharmacy Network Provider to be covered. If you are a Network Provider, you are responsible for submitting a prior authorization request directly to Blue Cross & Blue Shield of Mississippi for approval.
Prior Authorization Requests
Listed below are medications requiring prior authorization. Some Benefit Plans have a closed formulary for certain drugs. *Certain Growth Hormone Disease Specific Drugs are subject to a closed formulary based upon your patient's health benefit plan.
If you have questions about the prior authorization requirements for these medications, please call the Prescription Drug Service Team at 601-664-4998 or 1-800-551-5258.
**Prior Authorizations are required for all new high-dosage Crestor (20mg and 40mg) prescriptions that are prescribed by primary care providers. This requirement does not apply, at this time, to Cardiologists and Endocrinologists.
***Generic First Program applies.
If you are a Network Provider, use the myBlue Provider website to request a prior authorization. If you are a non-network or out-of-state provider, this link lets you begin a Prescription Drug Prior Authorization Request.
|Medications requiring Prior Authorization|
|Androgenic Steroids||Celebrex 400mg||Epoprostenol Sodium|
|Feiba VH||Hexilate FS||Kogenate FS|