Rx Updates for January 1, 2017

As we approach January, we want to ensure you are aware of the following critical information:

• Utilization management (UM) authorizations
  As a reminder, we are approaching a new benefit year. When members elect new benefits, existing authorization may no longer apply under the new benefit term. Therefore, new requests for medications which require Blue Cross and Blue Shield of North Carolina's (Blue Cross NC) approval may need be to be submitted for the new benefit period. 
• Finding the correct fax number to submit a UM request
  In order to prevent delayed processing, if you are not submitting requests through our online portal, CoverMyMeds, please send fax requests to the number listed by the physician signature. This is noted at the bottom of the question section on the fax form. Please do not submit requests to fax numbers listed in addendum pages.
• Two new formularies available in January
  As mentioned last month, Blue Cross NC will be adding the Essential and Net Results formularies in January. We encourage you to work with your patients to find preferred medications within your patient’s formulary to address their medical needs. Details about which medications require UM on these new formularies, and what to do if a suitable alternative is not available, will be available December 16, 2016 at http://www.bcbsnc.com/content/providers/ppa/prescriptions.htm.

If you have any questions, please contact us via the Provider Blue Line^SM at 1.800.214.4844.