Pharmacy Program Update: Preauthorization Requests for Prior Authorization and Step Therapy
Prime Therapeutics, our pharmacy benefit manager, conducts all Prior Authorization (PA) and Step Therapy (ST) preauthorization requests from physicians for Blue Cross and Blue Shield of Oklahoma (BCBSOK) members with prescription drug coverage.
A BCBSOK Preauthorization Request Physician Fax Form for each medication requiring preauthorization may be accessed in the Pharmacy Program/Prior Authorization and Step Therapy Programs section of our website at bcbsok.com/provider. Physicians must complete and submit a preauthorization request form for all PA and ST medications, as specified on our website. Benefits will continue to be available for medications if warranted by the patient’s medical history and current medical condition. The final decision regarding what medicines should be prescribed, regardless of the benefit determination, is a decision between the patient and their doctor.
Effective Nov. 1, 2011, all Preauthorization Request Physician Fax Forms have been updated to reflect the following contact information change for Prime:
Please remember to discard any BCBSOK PA and ST preauthorization request fax forms that you may have printed or downloaded previously, as they will not reflect the correct information.
The telephone number for Prime’s Clinical Review Department remains the same: 800-991-5643.
PA and ST programs may not apply to all prescription drug benefit plans. To determine if a specific benefit plan includes a PA or ST program, and which drug categories are included in the member's plan, call the Pharmacy Program number listed on the back of the member's ID card.
Prime Therapeutics LLC is a pharmacy benefit management company. BCBSOK contracts with Prime Therapeutics, a separate company, to provide pharmacy benefit management and other related services. BCBSOK, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.