Provider Central

• Use ConnectCenter or contact us.
• Commercial members do not have medical benefits for these medications and some employers customize benefits.
   Injectable specialty medication coverage pharmacy medical policy 071.
  

See if you need prior authorization and learn how to request prior authorization.

• Commercial members: Some medications have their own medical policy. Review our medical policies to see if prior authorization is required. You can also find prior authorization information in these policies:
   Medical Utilization Management (MED UM) & Pharmacy Prior Authorization Medical Policy 033
   Medical Benefit Prior Authorization Medication List Medical Policy 034

• Federal Employee Program members:
   Medical Benefit Prior Approval Drug List
  
  For high-cost medications that don’t need prior approval, you can ask for an Advanced Benefit Determination.
  • Fax your written request, along with relevant medical record documentation, to 1-888-282-1315. Write "Advanced Benefit Determination" on the cover page.

• Medicare Advantage members: We require step therapy and prior authorization for certain medications covered under our Medicare HMO Blue and Medicare PPO Blue members' Part B medical benefits.
  Medicare Advantage Part B Step Therapy Medicare Medical Policy 020
  Medicare Advantage Part B Medical Utilization Medicare Medical Policy 125