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MEDICARE Coverage limitations drug search

Find the criteria and fax forms for drugs requiring prior authorization, step therapy, quantity limits.

Are you a non-Medicare member?
Go to non-Medicare Drug Search

When you search for your drug, the criteria and corresponding fax form will be displayed, along with details on which plans require the review. Review the drug's information and follow the steps on your plan's form to submit a request.

You can ask our plan to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. 
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Disclosures:

Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal.

Blue Cross and Blue Shield of North Carolina is an HMO-POS D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Enrollment in Blue Cross and Blue Shield of North Carolina depends upon contract renewal. 

Blue Medicare Supplement plans offered: Plan A: BMS A, 1/24, Plan G: BMS G, 1/24, Plan HI DED G: BMS HDG, 1/24, Plan K: BMS K, 1/24, Plan N: BMS N, 1/24.

Medicare Supplement insurance plans are not connected with or endorsed by the United States Government or the federal Medicare program.

The federal government requires all Medicare Advantage members to continue paying their Part B premium each month.

Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, sexual orientation or source of payment. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.

Links marked with an external site icon indicate that you're leaving BlueCrossNC.com and Blue Cross and Blue Shield of North Carolina's plan information. The site you're going to is either a third-party vendor contracted with Blue Cross NC to provide services or an external website independent of Blue Cross NC.

To view PDF documents, you need to download and install Adobe Acrobat Reader on your computer.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers several decision-support tools to aid you in making decisions around your health care experience. These tools are offered for your convenience and should be used only as reference tools. You should consult your own legal counsel, tax advisor or personal physician as applicable throughout your health care experience.

Out-of-network / non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

The Blue FlexCard is issued by Stride Bank, N.A., Member FDIC, pursuant to license by Mastercard International. Stride Bank is an independent company offering debit card services and is solely responsible for its products.

Blue Cross NC contracts with independent companies to provide supplemental benefits. Those companies are responsible for the services they provide. They do not provide Blue Cross or Blue Shield products or services. Marks and trade names are property of their respective owners.

Change Healthcare is an independent company providing revenue and payment cycle management on behalf of Blue Cross and Blue Shield of North Carolina.

FitOn Health is an independent company providing health and fitness services on behalf of Blue Cross and Blue Shield of North Carolina.

SilverSneakers® is a registered trademark of Tivity Health. © 2025 Tivity Health, Inc. All rights reserved. Tivity Health is an independent company providing fitness services on behalf of Blue Cross and Blue Shield of North Carolina.

CareLinx is an independent company providing in-home care solutions on behalf of Blue Cross and Blue Shield of North Carolina.

TruHearing is an independent company providing hearing health and hearing aids on behalf of Blue Cross and Blue Shield of North Carolina.

Current as of 9/26/2025 | Y0079_13526_M CMS Accepted 09302025 | U36079, 7/25

Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

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© 2025 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.