BCBS Implements New Prior Authorization Program for Autoimmune Drugs


 

Blue Cross and Blue Shield of Alabama is implementing a new autoimmune biologic drug program, concerning pharmaceuticals treating conditions such as rheumatoid arthritis, plaque psoriasis, and Crohn's disease.

Beginning January 1, 2018, a prior authorization (PA) is required for members who are prescribed biologic medications for autoimmune disorders.

Blue Cross is taking extra steps to ensure that the PA process goes smoothly for our members:

• There will be no change to members who have a current prescription for an autoimmune drug. They will be able to continue taking their current medication without acquiring a PA and they can change to a preferred drug for their condition without requiring a new PA.

• Members who are diagnosed with an autoimmune disease and have claims for prerequisite drugs will automatically receive a PA for preferred drugs. Blue Cross and Blue Shield of Alabama will use data analytics to identify members who meet clinical criteria and proactively provide an authorization for coverage.

• Members who are prescribed a non-preferred drug will go through the initial PA process.

The PA process will simplify the administrative process for physician offices. This proactive initiative will help members with an autoimmune condition receive the best treatments without disruption.

 
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