Prescription Drugs Requiring Prior Authorization
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.
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.
Prescription drug benefits vary with a member'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.
Non-network and out-of-state providers can find a member's specific prescription drug formulary details by entering the Member ID and the provider's NPI on this prescription drug search page.
Prior Authorization Requests
If you have questions about the prior authorization requirements, please call the Prescription Drug Service Team at 601-664-4998 or 1-800-551-5258.
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.