7/17/2023 0 Comments Medicine pill look up![]() ![]() Not all medication lists or formularies have non-formulary medications. Non-formularyĪ non-formulary medication is one that isn't on a patient's Blue Cross NC medication list. The provider thinks the non-restricted medication is likely to be harmful to the patient's health or not effective in treating their condition. The patient has already used the non-restricted medication and it wasn't effective in treating the condition or Patients may be covered for a restricted medication if providers tell Blue Cross NC in writing that: Step Therapyīlue Cross NC requires that patients first try a medication or device that is not restricted before a restricted medication will be approved. This may mean taking fewer pills each day without changing the total strength of the medication. To encourage the proper use of prescription medications, Blue Cross NC may restrict the amount of medicine an insurance plan covers. Providers must explain in writing why patients need a certain medication before Blue Cross NC can decide if it will be covered. Our drug search tool shows the restricted medications our members use most, the requirements for approval, and the details you must send us to get them approved. Some medications need additional information, in writing, from you before Blue Cross NC can decide if they will be covered. Medications that Need Prior Authorization A comprehensive list of formulary medications and prior authorization requirements are found under "Helpful documents," just click the pdf with the formulary name. If you need to request prior authorization or there are other special requirements, those should be listed here, too.The medication name, description and cost tier info will appear below the search tool under "Selected medicines." Additional details, such as generic availability and pricing, are found under "See all pricing options.".Your patient's medication list, or formulary, search should look like this:ģ) Type a medication name in the blue search box, select the formulation and strength you are prescribing and click Submit. You'll go to Prime Therapeutics, our pharmacy benefit manager's website. Select the member's plan type from the menu.Answer Yes or No to the member ID card question.Click Find Doctor / Drug / Facility on the top toolbarĢ) On the Find a Doctor, Drug or Facility page.How to Find Your Patient's Approved Medication List or Formulary Non-Discrimination Policy and Accessibility Services. ![]() Get a Quote for Individual and Family PlansĪncillary and Specialty Benefits for Employees.Health Plans for Individuals and Families. ![]()
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