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:
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.
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.
View the list of medications that require authorizations then call as indicated below.
We have implemented several pharmacy programs that may impact the drug type, fill amounts or pharmacies available to patients.
Learn more about our generics programs.
The medical policies linked below are effective January 1, 2014. For current medical policies, go to iLinkBLUE and click on “Medical Policies Coverage Guidelines.”
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.
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