Prescription Plans

Many of our prescription drug plans have drug management programs for medications* dispensed by pharmacies. We provide many of the prior authorization forms and exception request forms below.

Please note: Medications administered by doctors and other health care providers should use the forms on the Health Plans page.

Specialty Drugs

Visit the CuraScript website for prior authorization fax forms for specialty drugs. CuraScript is an independent company that administers the specialty pharmacy program on behalf of BlueCross.

You can also call Care Continuum at 866-544-0857 or fax forms to 866-576-3869. Care Continuum is an independent company that processes specialty drug prior authorizations on behalf of BlueCross.

Non-Specialty Drug Prior Authorization Program

We require prior approval for drugs included in our prior authorization program for most members. To request prior authorization for non-specialty drugs, call Caremark's Prior Authorization department at 866-814-5506, or print the required prior authorization form and fax it to Caremark at 888-836-0730. Caremark is an independent company that assists in the administration of the program on behalf of BlueCross.

These are fax forms for drugs in our prior authorization program:

Abstral   Actiq   Adoxa   Advicor   Altoprev  Ambien   Ambien CR   Amitiza   Amnesteem   Anadrol-50   Androgel  
Atacand   Atacand HCT   Atralin  Avalide   Avapro   Avita   Beconase AQ   Celebrex 400 mg   Claravis   Cozaar  
Crestor   Detrol   Detrol LA   Differin   Diovan   Diovan HCT   Ditropan XL   Doryx   Dymista   Edarbi   Edarbyclor  
Edular   Emend   Fentora   Flonase   Fortamet   Forteo   FreeStyle Diabetic Test Strips   Glumetza   Gralise  
Hyzaar  Intermezzo   JentaDueto   Lamisil   Lazanda  Lescol   Lescol XL   Lipitor   Lumigan   Lunesta  
Mevacor   Monodox   Mybetriq   Nasacort AQ   Nuvigil   Oleptro   Olux-E   Omnaris   Onsolis   Oxandrin  
Oyxtrol  Pradaxa   Pravachol   Provigil   Qnasl   Regranex   Retin-A   Rhinocort AQ   Riomet   Sanctura  
Sanctura XR   Silenor   Sonata   Soriatane   Sotret   Sporanox   Suboxone   Subsys   Subutex   Tazorac  
Tekturna   Tekturna HCT   Testiml   Teveten   Teveten HCT   Toviaz   Tradjenta   Tretin-X   Veramyst   Vytorin  
Zetonna   Ziana   Zocor   Zolpimist 

Quantity Management Program

We limit the amount we cover for medications included in the quantity management program for many members. We cover higher quantities for some medications, when medical necessity is documented. 

Aciphex   Aloxi   Amerge   Anzemet   Avinza   Axert   butorphanol nasal spray   Celebrex   Dexilant   Duragesic  
Embeda   Emend   Exalgo   Frova   Imitrex Injectable   Imitrex Oral   Kadian   Kytril   Maxalt   MS Contin   Nexium  
Nexium-MtVernonMills   Opana   Oramorph   Oxycontin   Prevacid   Prilosec   Protonix   Relpax   Sancuso   Silenor
Sonata   Sumavel   Treximet   Zegerid   Zofran   Zomig   Zuplenz

Step Therapy Program

We require a generic or over-the-counter alternative trial before we cover medications included in the step therapy program for most members. We waive this requirement when medical necessity is documented.

Abilify   Aciphex   Allegra   Allegra-D   Amnesteem   Antara   Atralin   Avita   Claravis   Clarinex   Clarinex-D   Clozaril
Dexilant   Differin   Fanapt   Fenoglide   fexofenadine   fexofenadine-pseudoephedrine   Fibricor   Geodon  
Invega   Latuda   levocetirizine   Lipofen   Lofibra   omeprazole/bicarb   Prevacid   Prilosec    Pristiq   Protonix  
Retin A   Risperdal   Rozerem   Saphris   Seroquel   simvastatin   Solodyn   Sotret   Tazorac   Tretin-X   Tricor  
Triglide   Trilipix   Uloric   Veltin   Xyzal   Zegerid   Ziana   Zyprexa

Prior Authorization Forms Request

Providers who need a prior authorization form that is not available online should call Caremark's Prior Authorization department. For non-specialty drugs, call 800-294-5979. You can also fax a form request to Caremark at 888-836-0730.

State Health Plan Prescription Drug Coverage

The State Health Plan provides prescription drug coverage through Medco. Medco is an independent company that assists in the administration of the program on behalf of the State Health Plan. Call Medco at 800-211-1456 or visit Medco's website for more information.

*The medication names listed above may be the registered or unregistered trademarks of independent third-party pharmaceutical companies. These trademarks are included for informational purposes only and are not intended to imply or suggest any third-party affiliation.

Some links on this page lead to third party websites. Those parties are solely responsible for the contents and privacy policies on their sites.