Prior authorization is the process of obtaining prior approval for certain medications from health plan pharmacists and physicians before the medications are dispensed. Your doctor is required to obtain prior authorization before prescribing certain medications. This is generally required in cases where certain medical-necessity criteria must be met in order to receive coverage.
Working with your doctor, prior authorization checks that the medication you're prescribed is both necessary and appropriate for your condition. For a complete listing of medications requiring prior authorization, please refer to your Formulary Guide, or visit our website at www.bluecrossma.com, click on Pharmacy Program, and proceed to Medications That Require Prior Authorization.
For more information on your pharmacy program, please call Member Service at the number located on the front of your ID card.