Prescription Drug Polices

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.

Showing 1– 25 of 57 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
Blood Modifiers Open a PDF 7/1/2020
Botulinum Toxin (Medical Policy) Open a PDF 3/30/2020
Cimzia Open a PDF 6/15/2020
Clinical Review Prior Authorization (CRPA) Medical Drugs Open a PDF 6/08/2020
Clinical Review Prior Authorization Rx (CRPA) Open a PDF 6/08/2020
Compounded Drug Products Open a PDF 2/24/2020
Coronavirus (COVID-19) Impacted Drug Therapies (azithromycin, chloroquine, hydroxychloroquine, Kaletra, lopinavir/ritonavir, Plaquenil, Zithromax) Open a PDF 6/10/2020
Duchenne Muscular Dystrophy (DMD): (Exondys 51 (eteplirsen) and Vyondys 53 (golodirsen)) Open a PDF 7/1/2020
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 5/29/2020
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 6/09/2020
Infertility Open a PDF 11/6/2019
Inflammatory Conditions Clinical Review Prior Authorization (CRPA) Rx and Medical Drugs PDF Open a PDF 6/16/2020
Interleukin Antagonists for Asthma and Other Conditions: Nucala (mepolizumab), Cinqair (reslizumab), Fasenra (benralizumab), & Dupixent (dupilumab) Open a PDF 6/04/2020
Showing 1– 25 of 57 Results

Make a Comment

We invite practitioners to review & comment on our policies.