Medical Step Therapy Updates for Healthy Blue + MedicareSM (HMO D-SNP)

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, FDA-approved biosimilar agents to Avastin, Mvasi, and Zirabev will not be included in the preferred product step.

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 the nonpreferred medications listed below.

Clinical Criteria are publicly available on the provider website. Visit the Clinical Criteria page to search for specific criteria.

https://www.bluecrossnc.com/providers/blue-medicare-providers/healthy-blue-medicare

BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered marks of the Blue Cross and
Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross and
Blue Shield of North Carolina (Blue Cross NC) is an independent licensee of the Blue Cross and Blue Shield
Association.
BNCCARE-0256-22 January 2022