New specialty pharmacy medical step therapy requirements (Healthy Blue + Medicare HMO D-SNP)

Please note, this communication applies to Healthy Blue + Medicare^SM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.

Effective March 1, 2023, the status of Infed in current criteria documents will change in our existing specialty pharmacy medical step therapy review process. This update is to notify that Infed will change to non-preferred.

Also, effective for dates of service on or after March 1, 2023, Feraheme (ferumoxytol) will change to preferred for both brand and generic.

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.

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

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Blue Shield of North Carolina (Blue Cross NC) is an independent licensee of the Blue Cross and Blue Shield Association. All other marks are the property of their respective owners. 
NCBCBS-CR-012811-22-CPN12458 December 2022