Prior authorization
Some medicines require prior authorization by Blue Cross Complete. Your doctor will need to submit a prior authorization request using one of the following forms:
Your doctor must submit a request for a prior authorization for you. They must also submit an override of a drug restriction. Requests from pharmacists aren’t accepted.
Prior authorization process
Once we receive a request, we’ll review the information. After a decision has been made, you’ll receive a letter with the approval or denial. If it’s denied, we’ll let you know why. Your doctor will receive a letter or a fax with the same information.
We will cover the medicine if it’s medically necessary. If we don’t believe it’s medically necessary, we’ll send you a letter that tells you why. If you or your doctor disagree with our decision, you can appeal it.
Formulary medicines are preferred. If a non-formulary medicine is prescribed, we may require you to try the available formulary medicines first. If it doesn't work, or your doctor doesn’t think they’re appropriate for you, they can submit a prior authorization request for a non-formulary medicine.
If more assistance is needed, your doctor can call PerformRx Pharmacy Provider Services at 1-888-989-0057. Your doctor can fax a hard copy of the form to 1-855-811-9326.