Jan. 26, 2026
Effective Jan. 1, 2026, we’re updating our preferred drug strategy for specific prescription medications administered by a health care provider in a clinical setting. We identified therapeutic equivalents or alternatives for certain medications that have been reviewed and determined to be just as effective as the non-preferred drug. In accordance with our medical policies, coverage will be provided for preferred drugs when clinically appropriate. This will improve access to more affordable care for some of our commercial and individual plan members.
What’s changing? When submitting a prior authorization request for certain drugs with a therapeutic equivalent or alternative, you will receive a list of preferred drugs that are comparable and clinically appropriate. Blue Cross and Blue Shield of Oklahoma or Carelon Medical Benefits Management will process prior authorization requests for both the non-preferred drugs and the preferred drugs.
Before submitting a prior authorization request, you can learn which drugs are included in this process and the preferred therapeutic equivalent or alternative drugs by referring to our medical policies and the Medical Benefit Therapeutic Alternatives Summary.
- For Infliximab and biosimilars, see Medical Policy number RX501.051, “Infliximab and Associated Biosimilars,” for more information (medical policy disclosed Oct. 1, 2025).
- For Pegfilgrastim and biosimilars, see Medical Policy number RX502.061, “Oncology Medications,” for more information (medical policy disclosed Oct. 1, 2025).
- For Rituximab and biosimilars, see Medical Policy number RX502.030, “Rituximab and Biosimilars for Non-Oncologic Indications,” and Medical Policy number RX502.061, “Oncology Medications,” for more information (medical policies disclosed Oct. 1, 2025).
- For Trastuzumab and biosimilars, Medical Policy number RX502.061, “Oncology Medications,” for more information (medical policy disclosed Oct. 1, 2025).
Always check eligibility and benefits first through Availity® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
For more details on prior authorization
- Refer to utilization management and prior authorization for step-by-step instructions on how to submit prior authorization requests
- In addition to checking eligibility and benefits, see our prior authorization code lists and links to our digital lookup tool to determine if the drugs you’re recommending require prior authorization
Medical policies are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. Providers are encouraged to exercise their own clinical judgment based on each individual patient’s health care needs. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. Some benefit plans administered by BCBSOK, such as some self-funded employer plans or governmental plans, may not utilize medical policies. Members should contact the number on their member ID card for more specific coverage information.
Certain prescription drugs given to you by a health care provider in a clinical or professional setting have therapeutic equivalents or therapeutic alternatives that are used to treat the same condition. Your health plan benefits may only cover select therapeutic equivalent or therapeutic alternative drugs (“Medical Benefit Therapeutic Alternatives”). Learn more.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.
Carelon Medical Benefits Management (formerly AIM Specialty Health) is an independent company that has contracted with BCBSOK to provide utilization management services for members with coverage through BCBSOK. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK.
BCBSOK makes no endorsement, representations or warranties regarding third party vendors.