This article is for prescribers caring for our members
A new law1 takes effect October 1 that’s focused on health insurers’ medication step therapy protocols. These protocols establish the specific sequence in which a prescription medication for a specified condition is covered by health insurance as part of a utilization management program.
For Blue Cross to cover a medication, a member may be required to try a less expensive, but equally effective, option (lower step medication) before we’ll cover the higher step medication that the prescriber has requested. If the lower step alternative(s) is not clinically appropriate, we’ll review exception requests.
Here’s how Blue Cross is complying with the requirements of the law:
We appreciate you responding to requests for additional clinical information.
Contact Pharmacy Operations at 1-800-366-7778.
1. MGL Chapter 176O, Section 12A and B.
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