Update: Important Changes Regarding Blue Cross NC Prior Authorization Drug Requests

This is an update to the previous post from February 20, 2024. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is enhancing our ability to accept prior authorization drug requests electronically.

Impacted populations 

• This change only impacts Commercial (including ACA) and Medicare (including Experience Health℠) populations. 
• This change does not impact Medicaid, DSNP (Dual Eligible Special Needs Plans), or FEP (Federal Employee Program) populations.

Pharmacy drug requests 

• You can submit pharmacy drug requests through your preferred method – MHK, CoverMyMeds (CMM), or SureScripts. 
• A pharmacy drug request is a medication that will be billed under a member’s pharmacy benefit (most tablets, capsules, topicals, at-home injections administered by member, etc.; items available at a retail pharmacy).

Medical drug requests 

• Medical drug requests should be submitted electronically only through MHK (accessed via Blue e℠). 
• A medical drug request is a medication that will be billed under a member's medical benefit, including "buy and bill" scenarios (IV medications, injections administered in a provider’s office, etc.).

Training resources 

• MHK has training resources available, including the MHK manual published as a resource in Blue e. MHK also has two instructional videos you can watch to learn more about navigating MHK: 
  • Creating a Request with MHK 
  • Uploading a Document to an Existing Request with MHK 
• SureScripts has provider education available.

Questions?

• Please review the FAQs found here (PDF).
• If you have questions about this change, call 800-214-4844 for the Blue Cross NC Provider Blue Line.
• For questions regarding Blue e, please contact the Blue e Help Desk Team.
• For any questions regarding the functionality in utilizing the MHK Provider Portal, please contact us.
• For CMM, use the chat feature on their website, Cover My Meds, or call 866-452-5017.
• For SureScripts, call their Customer Support line at 866-797-3239.