Use the Medicare prior authorization drug search tool to access each drug's criteria and request forms. Visit the Prescription Drugs page for more information on formularies and drugs with limited coverage.

Blue Cross NC uses MCG care guidelines to help review medical necessity for health service requests. MCG care guidelines are the protected intellectual property of MCG.

Reference guidelines are informational tools developed by Medicare Advantage plans to help clarify:

• Processes used in care management.
• Requirements and limitations imposed by CMS.
• Interpretation of CMS mandates, especially where formal policies may not provide full operational detail.

They are not substitutes for medical policies, but rather supplemental resources to guide internal decision-making and provider understanding.