April 16, 2021 Update: This communication has been updated to include edits to Phase 1 and Phase 2 of the Medical Drug Phased Reference List. These changes and updates will take effect during Phase 2 of the medical drug authorization process.
April 8, 2021 Update: This communication has been updated to include the corrected fax number for the CMM Portal.
February 11, 2021 Update: This communication has been updated to include flow charts illustrating process changes and submission guidelines for medical drug authorizations.
February 3, 2021 Update: This communication has been updated to include updated dates for Phase 1 and 2, along with revised links to the Medical Drug Phased Reference List linked below.
Effective April 28, 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement a new process for our pharmacy department when submitting requests for drugs. Blue Cross NC is shifting its medical drug authorization process to CoverMyMeds and the pharmacy call center team. This change aims to improve turnaround times when submitting prior authorizations for medical drugs, allow a more streamlined experience and efficient process for drug authorizations and member claims processing and allow for a more user-friendly process for providers. Please see below for what to expect.*
Phase 1, starting April 28, 2021:
- Click here to download a list of medical drugs that will move from Care Radius to CoverMyMeds. View the page titled, “Phase 1” to see which drugs are included in this first phase.
- Providers should continue submitting all other drugs not on the phase 1 list through the existing process (i.e., Care Radius or 800-571-7942).
- As of April 28, providers can follow the phone instructions on the first page of the document if they have questions about any medical drugs (regardless of phase).
- If a provider has a question regarding a medical drug authorization that was completed in Care Radius prior to the April 28 transition, they should follow these same phone instructions. The pharmacy call center staff will assist the provider with updates or denial next steps.
- Phase 1 medical drug Corporate Medical Policies and associated fax forms will be moving to www.bluecrossnc.com/umdrug. We will notify you when this shift occurs via another news article. Once this move occurs, you may notice some formatting/layout changes to policies. If there is a policy change, this will be communicated separately.
Phase 2, starting June 16, 2021:
- In the same document linked above, there is a page with a list of phase 2 drugs.
- On or after June 16, 2021, providers should follow the instructions on the first page of the document to request authorization or assistance for phase 2 drugs.
- Currently, most medical drugs will have transitioned to CoverMyMeds.
*Please note: Phase 1 and 2 effective dates and the drugs and HCPCS codes listed in each phase are subject to change. We will be sure to communicate any of those potential changes in a timely manner. If you have any questions, please contact firstname.lastname@example.org.