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New Specialty Pharmacy Medical Step Therapy Requirements (Healthy Blue + Medicare (HMO D-SNP))
Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.
Effective June 1, 2023, the following Part B medications from the current Clinical Criteria 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 Criteria guidelines are publicly available on the provider website. Visit the Clinical Criteria page to search for specific criteria.
| Clinical UM Guidelines | Preferred drug(s) | Nonpreferred drug(s) |
|---|---|---|
| CC-1017 (PDF) | Avastin Mvasi | Alymsys Vegzelma Zirabev |
For more information, visit Healthy Blue + Medicare.
Blue Cross and Blue Shield of North Carolina Senior Health, DBA Blue Cross and Blue Shield of North Carolina, is an HMO 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 Senior Health depends upon contract renewal
NCBCBS-CR-022279-23-CPN22010 April 2023
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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