New Specialty Pharmacy Medical Step Therapy Requirements (Healthy Blue + Medicare HMO D-SNP)
Please note, this communication applies to Healthy Blue + MedicareSM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.
Effective March 1, 2023, the status of Infed in current criteria documents will change in our existing specialty pharmacy medical step therapy review process. This update is to notify that Infed will change to non-preferred.
Also, effective for dates of service on or after March 1, 2023, Feraheme (ferumoxytol) will change to preferred for both brand and generic.
Step therapy review will apply upon precertification initiation, in addition to the current medical necessity review (as is current procedure). Step therapy will not apply for members who are actively receiving medications listed below.
Clinical UM Guidelines are publicly available on the provider website. Visit the Clinical Criteria page to search for specific criteria.
Clinical UM Guidelines: ING-CC-0182
Preferred drug(s)
- Feraheme (ferumoxytol)
- Ferrlecit (sodium ferric gluconate/sucrose complex)
- Venofer (iron sucrose)
Nonpreferred drug(s)
- Infed (iron dextran)
- Injectafer (ferric carboxymaltose)
- Monoferric (ferric derisomaltose)
For more information, visit Healthy Blue + Medicare.
NCBCBS-CR-012811-22-CPN12458 December 2022