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New Specialty Pharmacy Medical Step Therapy Requirements Effective March 1
Please note, this communication applies to Healthy Blue + MedicareSM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.
Effective March 1, 2022, the following Part B medications from the current Clinical Utilization Management (UM) Guidelines will be included in our medical step therapy precertification review process. Step therapy review will apply upon precertification initiation, in addition to the current medical necessity review (as is current procedure). Step therapy will not apply for members who are actively receiving medications listed below.
Clinical UM Guidelines are publicly available on the provider website. Visit the Clinical Criteria page to search for specific criteria.
- Clinical UM Guidelines: ING-CC-0062
- Preferred drug(s): Inflectra, Remicade, Infliximab (unbranded)
- Nonpreferred drug(s): Avsola, Renflexis
Access more provider information, forms, policies and resources for our Healthy Blue + Medicare plan.
BNCCARE-0269-22 March 2022
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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