Physician Drug Authorizations

Authorizations for Targeted Meds and Step Therapy

Authorizations for Targeted Medications and Step Therapy must be requested from Express Scripts, Inc., (ESI), our pharmacy benefits manager. There are three ways to contact ESI for authorizations:

  • Fax authorization requests to ESI at 1.877.837.5922
  • Call ESI directly at 1.800.842.2015
  • Call Blue Cross' Provider Services at 1.800.922.8866 and select the ESI option to be transferred to ESI (choose option 2 for Authorizations, then option 2 for New Authorization, then option 3).

Physician Buy & Bill

Please have all codes for which you will be billing to Blue Cross ready when contacting ESI. It is imperative that these codes are captured by ESI to ensure appropriate reimbursement. The authorization process for non-targeted medications remains unchanged.

Request Authorizations

By Fax

Universal Prior Authorization Fax Form (Providers fax to: 1.877.837.5922)
NOTICE: Per R.S. 22:1006.1, the Louisiana legislature now requires health insurers to use a single, standardized prior authorization form for obtaining prior authorization for prescription drug benefits. Please use this form for both prior authorization and step therapy medications.

By Phone

View the list of medications that require authorizations then call as indicated below.

Other Drug Resources and Policies

We have implemented several pharmacy programs that may impact the drug type, fill amounts or pharmacies available to patients.

Generics Programs

Learn more about our generics programs.

Drug Medical Policies Effective January 1, 2017

We have developed 21 new medical policies as well as revised five existing medical policies that will go into effect on January 1, 2017*.

Summary of New and Revised Medical Policies Effective January 1, 2017

New Medical Policies:

Policy No.

Policy Name


Branded Gabapentin Products


buprenorphine (sublingual)


Branded Bupropion Products


Select Cyclobenzaprine Products


Inhaled Antibiotics for Cystic Fibrosis (tobramycin, Tobi®, Tobi Podhaler™, Bethkis®, Cayston®)


Autoinjectable Methotrexate Products (Otrexup™, Rasuvo®)


Oravig® (miconazole buccal tablets)


Rayos® (prednisone delayed release tablets)


Select Antiherpetic Agents (topical, buccal)


Topical Immunomodulators (Elidel®, Protopic®, generics)


Anticoagulant Agents (Pradaxa®, Savaysa®)


Select Inhaled Respiratory Agents


Topical Antifungals


mecamylamine (Vecamyl®)


Zyflo®/Zyflo CR® (zileuton)


pyrimethamine (Daraprim®)


penicillamine (Cuprimine®)/trientine (Syprine®)


sodium oxybate (Xyrem®)


Evzio® (naloxone auto-injector)


Extended Release Topiramate Products


Products For Dry Eye Disease (Restasis®, Xiidra™)

Revised Medical Policies:

* Under Louisiana Law, some patients may not be affected by these policy changes until their 2017 contract renewal.

Note: On behalf of Blue Cross and Blue Shield of Louisiana, prior authorizations are administered by Express Scripts, Inc., an independent pharmacy benefit management company. Please note that the authorization is not a guarantee of payment. Payment is subject to the member's eligibility, benefits, and pre-existing condition limitations at the time the services are provided. We recommend you contact BCBSLA at 1.800.922.8866 to verify benefits. The submitting provider certifies that the information contained herein is true, accurate, and complete and the requested services are medically necessary to the health of the patient.