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Prescription Drug Polices

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Prescription Drug Polices - Top Content

The following is a list of our prescription drug policies. If you cannot find a policy for a specific medication, please select the link titled 'Clinical Review Prior Authorization' from the list below.

*Pharmacy benefit drugs - Excellus BlueCross BlueShield continues to manage the pharmacy benefit for Medicaid Managed Care and Child Health Plus members. Use the Excellus Pharmacy Management Drug Policies below.

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Showing 1– 25 of 58 Results
Title Last Updated
Acthar Open a PDF 05/16/2020
Alpha-1 Antitrypsin Therapy (AAT) Open a PDF 3/25/2020
Anorexiants Open a PDF 3/11/2020
Antihemophilic Agents Open a PDF 4/20/2020
Attention Deficit Hyperactivity Disorder (ADHD) Stimulants Policy Open a PDF 1/2/2020
Avastin (bevacizumab) & Mvasi (bevacizumab-awwb) Open a PDF 1/6/2020
Blood Modifiers Open a PDF 5/12/2020
Botulinum Toxin (Medical Policy) Open a PDF 3/30/2020
Cimzia Open a PDF 2/27/2020
Clinical Review Prior Authorization (CRPA) Medical Drugs Open a PDF 3/23/2020
Clinical Review Prior Authorization Rx (CRPA) Open a PDF 5/15/2020
Compounded Drug Products Open a PDF 2/24/2020
Coronavirus (COVID-19) Impacted Drug Therapies (Albuterol HFA, azithromycin, chloroquine, hydroxychloroquine, Kaletra, levalbuterol HFA– brands/generics, lopinavir/ritonavir, Plaquenil, Zithromax Open a PDF 5/1/2020
Duchenne Muscular Dystrophy (DMD): (Exondys 51 (eteplirsen) and Vyondys 53 (golodirsen)) Open a PDF 2/20/2020
Enbrel Open a PDF 2/27/2020
Generic Advantage Program / MAC Penalty Open a PDF 7/24/2019
Growth Hormone Open a PDF 2/3/2020
Headache Disorders Open a PDF 3/20/2020
Hepatitis-C Commercial Rx Open a PDF 4/8/2020
Hepatitis-C Medicaid Rx Open a PDF 4/8/2020
Hereditary Angioedema (HAE) Open a PDF 1/13/2020
Humira Open a PDF 4/21/2020
Inborn Errors of Metabolic Diseases (IEM) Open a PDF 4/24/2020
Infertility Open a PDF 11/6/2019
Inflammatory Conditions Clinical Review Prior Authorization (CRPA) Rx and Medical Drugs PDF Open a PDF 5/1/2020
Showing 1– 25 of 58 Results

Prescription Drug Polices - Make a Comment Card

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We invite practitioners to review & comment on our policies.