Some medications require prior approval from BCBSNC before the prescription can be accepted for payment.
Prior approval requires that your physician contact BCBSNC at 1-800-672-7897 or fax a request form to 1-800-795-9403.
| Drugs Requiring Prior Approval |
Utilization Management Criteria |
Physician Fax Request Form |
| Growth Hormones |
All Growth Hormones |
Call 1-800-672-7897 for prior approval |
| Insulin-like Growth Factors |
All Insulin-like Growth Factors |
Call 1-800-672-7897 for prior approval |
Cox 2 Inhibitors
(e.g. Celebrex®) |
All Cox 2 Inhibitors |
Use Cox 2 Fax Request Form |
Antifungals
(Lamisil®, Sporanox®) |
Antifungals |
Use Antifungal Fax Request Form |
| Disease Modifying Antirheumatic Drugs |
|
|
| All Botulinum Toxins |
FDA approved conditions |
Call 1-800-672-7897 for prior approval |
| Antipsoriatics |
|
|
Respiratory
(Xolair®) |
Xolair® |
Use Xolair® Fax Request Form |
Orencia®
Remicade®
Rituxan® (for Rheumatoid Arthritis ONLY) |
| |
Intravenous Immune Globulins (IVIg)
(Effective 1/1/2010)
- Carimune NF
- Flebogamma
- Flegogamma DIF
- Gammagard Liquid
- Gammagard S/D
- Gamunex
- Octagam
- Privigen
Subcutaneous Immune Globulins (SCIg)
(Effective 1/1/2010)
- Vivaglobin |
IV and SC immune globulin |
Prior review for immune globulins effective 1/1/2010 |
| Transmucosal Fentanyl |
|
|
| Proton Pump Inhibitors (PPIs)* (updated 2/16/09) |
- Aciphex®
- Kapidex™
- Lansoprazole Powder (for pharmacy
compounding only; doesn't include Prevacid brand products)
- Prevacid®
- Prilosec® for oral suspension
- Protonix® 40mg Suspension
- Zegerid®
|
Use PPI Fax Request Form Requests DO NOT need to be submitted for the preferred PPIs omeprazole, pantoprazole, or Nexium-®
|
| Intranasal Steroids* (effective 10/1/09) |
- Beconase AQ®
- Nasacort AQ®
- Omnaris®
- Rhinocort Aqua®
- Veramyst®
|
Use Intranasal Steroids Fax Request Form Requests DO NOT need to be submitted for the preferred intranasal steroids flunisolide, fluticasone propionate, or Nasonex. |
| Oral Bisphosphonates* (effective 10/1/09) |
- Actonel®
- Actonel® with Calcium
|
Use Oral Bisphosphonates Fax Request Form Requests DO NOT need to be submitted for the preferred bisphosphonates alendronate, Fosamax Plus D, or Boniva. |
*The nonpreferred PPIs, intranasal steroids and oral bisphosphonates listed will be considered restricted access drugs that require an initial physician certification prior to being covered.
BCBSNC covers certain medications up to a set quantity. Quantity limitations are designed to help identify excessive usage of drugs.
If a physician feels it is medically necessary to exceed quantity limitations on your medication, they must get prior approval from BCBSNC at 1-800-672-7897 before a higher quantity will be covered.
To learn more about prior approval or quantity limitations for enrolled federal and state employees, please visit the