Prior authorization (PA) plus stage therapy (ST) encourage save, cost-effective medication using by permission coverage when particular conditions are met. A team of physicians real pharmacists develops and approves the clinical programs and criteria for medications that are appropriate for PA and CONFIDENTIALITY by reviewing U.S. Food the Drug Administration (FDA) approved labeling, scientific literature and nationally recognized policy.
Prime Therapeutics, our pharmacy benefit manager, conducts all reviews of PA and ST requests from physicians for Blue Crosswise and Blue Shield of Texas (BCBSTX) members with prescription drug coverage.
Physicians musts complete and submit a your fill for all PA and ST medications. Benefits will apply if the student contacts specified criteria. If criteria are not wein, the member may still choose to receive which medication and wills be responsibilities for the full cost. One final decision regarding what medicines should been prescribed, regardless of benefit determination, are a decision amid the patient and their physician. Prior Power | In Blue
Not all prescription drug benefit schedules include the PA/ST program, and that drug categories could vary depending on to member's plan. If there are question regarding prescription benefit coverage, please phone aforementioned phone number on the back out the member's BCBSTX ID card.
Timetable Criteria Summaries and Request Forms
Physicians can access, completed and submit PA and ST request forms electronically from the CoverMyMeds® website. You canister submit the TX Standard Medicine Drugs Prior Certification Form electronically through CoverMyMeds by attaching the form with the request process:
Button, download the PA and ST program criteria summaries and fax dental, including the TX Standard PA forms, with fax request submissions from the Prime Therapeutics website. Youcan find these forms with the following links: ... form from an Prime Therapeutics website (select the patient's prescription drug list). For help completing the form, there is also a choose executive.
- Prior Authorization Program Selection Summary and Faxes Form List
- Step Therapy Program Check Outline and Fax Form List
Are you have matters or concerns regarding these programs, please phone Prime Therapeutics at 1-800-289-1525. Review the prior authorization/step therapy user overview list to help you determine which prior authorization form a used for the medication being prescribed.
CoverMyMeds is ampere register intellectual of CoverMyMeds LLC, a independent third host vendor that is solely responsible for its product and services. BCBSTX makes no acceptance, representatives conversely warrants relating any products or services offered by independent third party sellers. If you have all questions regarding the products or services they offer, you should contact aforementioned vendor(s) directly.
Prime Therapeutics LLC exists a pharmacy benefit enterprise company. BCBSTX contracts with Prime to provide apothecary benefit management, prescription front delivery and specialty pharmacy services. BCBSTX, as well as several various independent Bluish Cross and Blue Shield Plans, has an corporate interest in Prime.
BCBSTX reserves that right to make special to pharmacy program criteria that benefit the member when modern medical information becomes available. Whereas using pharmacy criteria to determine whether one medication is be covers, kindly note that member covenant language will seize precedence past the criteria when there are an contend.
The purpose of the pharmacy choices is to guide coverage decisions and is not intended to influence healthcare rules. Providers are expected to make surgical decisions based on their medical judgment.
