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.
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:
Branded Gabapentin Products
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
Zyflo®/Zyflo CR® (zileuton)
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:
Metformin and Metformin Containing Products
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors, DPP-4 Inhibitor Combination Drugs, Cycloset® (bromocriptine)
GLP-1 Agonists for Diabetes
HMG-CoA Reductase Inhibitors and HMG-CoA Reductase Inhibitor Combination Drugs
Sodium-Glucose Co-Transporter-2 (SGLT-2) Inhibitors and Combination Products
* 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.
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