Blue Cross NC Expands Specialty Pharmacy Precertification List (Healthy Blue + Medicare HMO-DSNP)

Please note, this communication applies to Healthy Blue + Medicare^℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.

Effective for dates of service on and after December 1, 2022, the specialty Medicare Part B drug listed below will be included in our precertification review process.

Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.