Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Back
Medical Policy Update For March 15, 2022 March 15, 2022

The following policies have been permanently moved from the Medical Policy pages to the Prior Review and Limitations page. To locate a policy, search by drug name in the "Drugs that Need Prior Authorization" section.

  • Abatacept (Orencia®)
  • Aducanumab-avwa (Aduhelm™)
  • Alemtuzumab (Lemtrada®)
  • Allogeneic Processed Thymus Tissue-agdc (Rethymic®)
  • Alpha 1-Antitrypsin Inhibitor Therapy (example: Aralast NP™)
  • Anifrolumab-fnia (Saphnelo™)
  • Antiemetic Injection Therapy (example: Aloxi®)
  • Antisense Oligonucleotide Therapy for Duchenne Muscular Dystrophy (example: Amondys 45®)
  • Belimumab (Benlysta®)
  • Bezlotoxumab (Zinplava™)
  • Bimatoprost Intracameral Implant (Durysta™)
  • Botulinum Toxin Injection (example: Dysport®)
  • Brexanolone (Zulresso™)
  • Buprenorphine Extended-Release (Sublocade®)
  • Burosumab-twza (Crysvita®)
  • Canakinumab (Ilaris®)
  • CAR-T Therapy (example: Yescarta®)
  • Certolizumab pegol (Cimzia®)
  • Crizanlizumab (Adakveo®)
  • Denosumab (Prolia®, Xgeva®)
  • Eculizumab (Soliris®)
  • Edaravone (Radicava®)
  • Efgartigimod Alfa-fcab (Vyvgart™)
  • Emapalumab-lzsg (Gamifant™)
  • Enzyme Replacement Therapy (ERT) for Lysosomal Storage Disorders (example: Cerezyme®)
  • Eptinezumab-jjmr (Vyepti™)
  • Erythropoietin Stimulating Agents (example: Epogen®)
  • Esketamine (Spravato®) Nasal Spray
  • Evinacumab-dgnb (Evkeeza™)
  • Fosdenopterin (Nulibry™)
  • Givosiran (Givlaari®)
  • Golimumab (Simponi Aria®)
  • Guselkumab (Tremfya®)
  • Ibalizumab-uiyk (Trogarzo®)
  • Immunoglobulin Therapy (example: Asceniv™)
  • Inclisiran (Leqvio®)
  • Inebilizumab-cdon (Uplizna™)
  • Infliximab (Remicade®) and Infliximab Biosimilars
  • Injectable and Healthcare Administered Oncology Drugs (example: Abraxane®)
  • Injectable Clostridial Collagenase for Fibroproliferative Disorders (example: Xiaflex®)
  • Interleukin-5 Antagonists (example: Fasenra®)
  • Intra Articular Hyaluronan Injections for Treatment of Osteoarthritis of the Knee (example: Durolane®)
  • Intravenous Iron Replacement Therapy (example: Injectafer®)
  • Letermovir (Prevymis™)
  • Lumasiran (Oxlumo™)
  • Luspatercept-aamt (Reblozyl®)
  • Natalizumab (Tysabri®)
  • New to Market Specialty Drug PPA Requirements
  • Nusinersen (Spinraza®)
  • Ocrelizumab (Ocrevus®)
  • Ocular Angiogenesis Inhibitor Agents (example: Beovu®)
  • Omalizumab (Xolair®)
  • Onasemnogene abeparvovec (Zolgensma®)
  • Patisiran (Onpattro®)
  • Pegcetacoplan (Empaveli™)
  • Pegloticase (Krystexxa®)
  • Place of Service for Medical Infusions
  • Plasminogen, human-tvmh (Ryplazim®)
  • Pulmonary Hypertension, Drug Management (example: (Flolan®)
  • Ravulizumab-cwvz (Ultomiris®)
  • Repository Corticotropin (Acthar® Gel)
  • Respiratory Syncytial Virus Prophylaxis (example: Synagis®)
  • Rituximab for the Treatment of Rheumatoid Arthritis (example: Truxima®)
  • Romiplostim (NPlate®)
  • Romosozumab-aqqg (Evenity™)
  • Somatostatin Analogs (example: Somatuline® Depot)
  • Sutimlimab (Enjaymo™)
  • Teprotumumab-trbw (Tepezza™)
  • Testosterone Pellet Implantation for Androgen Deficiency (example: Testopel®)
  • Tezepelumab-ekko (Tezspire™)
  • Tildrakizumab-asmn (Ilumya®)
  • Tocilizumab (Actemra®)
  • Treatment of Hereditary Angioedema (example: Berinert®)
  • Trilaciclib (Cosela™)
  • Ustekinumab (Stelara®)
  • Vedolizumab (Entyvio®)
  • Voretigene neparvovec (Luxturna®)
  • White Blood Cell Growth Factors (example: Fulphila®)

 

 

 

 

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.

Information in other languages: Español   中文   Tiếng Việt   한국어   Français   العَرَبِيَّة   Hmoob   ру́сский   Tagalog   ગુજરાતી   ភាសាខ្មែរ   Deutsch   हिन्दी   ລາວ   日本語

© 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.