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, 2015

We have developed three new medical policies as well as revised four existing medical policies that will go into effect on January 1, 2015.

New Medical Policies:

Policy No. 00440: itraconazole (Onmel)®
Members will be granted approval for 12 weeks of consecutive therapy with the brand name itraconazole product, Onmel®, only if there is clinical evidence or patient history that suggests the use of generically available oral itraconazole products will be/was ineffective or will/did cause an adverse reaction to the patient. This new policy will affect patients that are newly prescribed Onmel® effective January 1, 2015.*

Policy No. 00451: Phosphate Binders (Branded)
Members will be granted approval for branded phosphate binder products (e.g. Velphoro®, Fosrenol®) only if there is clinical evidence or patient history that suggests the use of generic calcium acetate or generic sevelamer products will be/was ineffective or will/did cause an adverse reaction to the patient. This new policy will affect patients that are newly prescribed branded phosphate binder products (e.g. Velphoro®, Fosrenol®) effective January 1, 2015.*

Policy No. 00453: interferon beta 1-b (Betaseron)®
Members should use the preferred interferon beta 1-b product, Extavia®, unless there is clinical evidence or patient history that suggests the use of Extavia® will be/was ineffective or will/did cause an adverse reaction to the patient. If this criterion is met, approval for the nonpreferred interferon beta 1-b product, Betaseron®, will be granted. This new policy will affect members currently utilizing Betaseron® as well as members that are newly prescribed Betaseron® effective January 1, 2015.*


Revised Medical Policies:

Policy No. 00306: Dipeptidyl Peptidase-4 (DPP4) Inhibitors, DPP-4 Inhibitor Combination Drugs, Cycloset® (bromocriptine)
Members subject to prior authorization should use the preferred DPP-4 inhibitor or DPP-4 inhibitor combination products Januvia®, Janumet®, Janumet XR®, Onglyza®, or Kombiglyze XR® unless there is clinical evidence or patient history that suggests the use of these products will be/was ineffective or will/did cause an adverse reaction to the patient. If this criterion is met, approval for a non-preferred product (e.g. Tradjenta®, Jentadueto®, Nesina®, Kazano®) will be granted. Members that are subject to step-therapy will still need to try metformin or metformin containing products prior to using these products. This updated policy will affect members currently utilizing a non-preferred DPP-4 inhibitor or non-preferred DPP-4 inhibitor combination product (e.g. Tradjenta®, Jentadueto®, Nesina®, Kazano®) as well as members that are newly prescribed a non-preferred DPP-4 inhibitor or non-preferred DPP-4 inhibitor combination product (e.g. Tradjenta®, Jentadueto®, Nesina®, Kazano®) effective January 1, 2015.*

Policy No. 00322: Diabetic Test Strips
Members should use the preferred blood glucose test strips (Contour®, Breeze 2®, or True®) unless there is clinical evidence or patient history that suggests the use of Contour®, Breeze 2®, or True® blood glucose test strips will be/was ineffective or will/did cause an adverse reaction to the patient (including visual impairment or use of an insulin pump that requires a non-preferred blood glucose test strip). If this criterion is met, approval for a non-preferred product will be granted. This updated policy will affect members currently utilizing a nonpreferred blood glucose test strip as well as members that are newly prescribed a nonpreferred blood glucose test strip effective January 1, 2015.*

Policy No. 00335: Topical Testosterone Products
In addition to meeting the existing prior authorization criteria for topical testosterone products, members should use the preferred topical testosterone products, Axiron® or Androgel®, unless there is clinical evidence or patient history that suggests the use of Axiron® or Androgel® will be/was ineffective or will/did cause an adverse reaction to the patient. If this criterion is met, approval for a non-preferred topical testosterone product (e.g. Fortesta®, Striant®, Testim®) will be granted. This updated policy will affect members currently utilizing a non-preferred topical testosterone product (e.g. Fortesta®, Striant®, Testim®) as well as members that are newly prescribed a non-preferred topical testosterone product (e.g. Fortesta®, Striant®, Testim®) effective January 1, 2015.*

Policy No. 00348: Angiotensin II Receptor Blockers and Angiotensin II Receptor Blocker Combination Drugs
Members subject to prior authorization should use the preferred angiotensin II receptor blocker (ARB) or ARB combination products Benicar® or Benicar HCT® unless there is clinical evidence or patient history that suggests the use of Benicar® or Benicar HCT® will be/was ineffective or will/did cause an adverse reaction to the patient. If this criterion is met, approval for a non-preferred product (e.g. Edarbi®, Edarbyclor®) will be granted. Members that are subject to step-therapy will still need to try a generic product prior to using a brand name product or meet any of the step therapy override criteria. This updated policy will affect members currently utilizing a non-preferred ARB or ARB combination product (e.g. Edarbi®, Edarbyclor®) as well as members that are newly prescribed a non-preferred ARB or ARB combination product (e.g. Edarbi®, Edarbyclor®) effective January 1, 2015.*

* Under Louisiana Law, some patients may not be affected by these policy changes until their 2015 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.