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Drugs Requiring Approval Provider Premera Blue Cross

Details: Drugs may be added or deleted from this list without prior notification. If you have questions concerning the Pharmacy Prior Authorization Edit Program, please call the Pharmacy Services Center at 888-261-1756 or fax 888-260-9836, Monday through Friday, 8 a.m. to 5 p.m. Pacific Time.

› Verified 8 days ago

› Url: https://www.premera.com/wa/provider/pharmacy/understanding-your-benefits/drugs-requiring-approval/ Go Now

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Formulary LIST OF COVERED DRUGS

Details: The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, “Cardiovascular”. If you know what your

› Verified 9 days ago

› Url: https://www.premera.com/documents/027877_2020.pdf Go Now

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Rx Search Provider Premera Blue Cross

Details: Use Premera’s Rx search tool to get helpful information about prescription drugs, including costs, how a drug may be covered, and alternate drugs you can choose from.

› Verified 7 days ago

› Url: https://www.premera.com/wa/provider/pharmacy/drug-search/rx-search/ Go Now

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New Preventive Drug Lists for Premera Members Provider

Details: This means that these drugs are now provided to our members at no cost share. Our newly updated standard preventive drug lists include: PV Lite - For groups interested in achieving the most cost savings, while still offering the minimum required preventive drug coverage. PV Core - Standard option for fully insured group plans.

› Verified 2 days ago

› Url: https://www.premera.com/wa/provider/news/pharmacy/preventive-drug-lists/ Go Now

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Essentials Drug List PBC

Details: Drugs with lower-cost, over-the-counter alternatives • Drugs sold at inflated prices All excluded drugs have a therapeutic alternative. Talk with your doctor about what is right for you. In some cases, a non-prescription, over-the-counter (OTC) form of the drug may be a …

› Verified 4 days ago

› Url: https://www.premera.com/documents/043987.pdf Go Now

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5.01.621 Drugs for Weight Management

Details: Initial authorization Drugs listed in policy may be approved up to 6 months. Re-authorization criteria Future re-authorization of drugs listed in policy may be approved up to 12 months when clinical benefit/response at the time of re-authorization show: • Weight loss of ≥ …

› Verified 2 days ago

› Url: https://www.premera.com/medicalpolicies/5.01.621.pdf Go Now

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Drug List Changes Provider Premera Blue Cross

Details: *These drugs have been selected by an independent group of experts made up of doctors and pharmacists. This group reviews drugs to see how well they work relative to their cost. They also compare their effectiveness to similar drugs used to treat the same condition. Please talk with your doctor to see if these new options are right for you.

› Verified 4 days ago

› Url: https://www.premera.com/wa/provider/pharmacy/drug-search/upcoming-formulary-changes/ Go Now

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Preferred B3/B4 Formulary Effective -01-2021

Details: selects drugs for coverage based on each drugs safety, effectiveness, and cost. The committee meets at least quarterly to review new drugs to market to determine placement on this list and also reviews new information related to safety, effectiveness, and cost for existing drugs

› Verified 4 days ago

› Url: https://www.premera.com/documents/052147.pdf Go Now

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Essentials Formulary E1/E4 Effective 11-01-2021

Details: drugs typically used to treat chronic, complex, or rare conditions and may require enhanced clinical support. Specialty Drugs are generally limited to a month supply on dispense. Please check your member booklet for more details. Non-Preferred Drugs (4) Tier 4 includes generic, brand and specialty drugs. Non preferred drugs are

› Verified 4 days ago

› Url: https://www.premera.com/documents/052149.pdf Go Now

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Pharmacy Benefit Guide Provider Premera Blue Cross

Details: Preventive Drugs - Certain generic preventive drugs will have a very low or no cost share. Who decides a drug's value? A drug's value is based on science. An independent set of experts made up of leading physicians, pharmacists, health economists, a bioethicist, and a …

› Verified 6 days ago

› Url: https://www.premera.com/wa/provider/pharmacy/understanding-your-benefits/pharmacy-benefit-guide/ Go Now

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Changes to 2022 Essential Drug Exclusion List Provider

Details: Drugs with lower-cost, over-the-counter alternatives Brand-name drugs with lower-cost, competing brand-name alternatives A letter was sent to affected members on November 1, 2021, asking them to contact their provider about alternative treatments. All excluded drugs have a therapeutic alternative.

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› Url: https://www.premera.com/wa/provider/news/pharmacy/drug-exclusion-list/ Go Now

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How to dispose of prescription drugs safely Premera Blue

Details: And drugs prescribed by a doctor are often involved. More than half of teens who abuse prescription medicine get it from a family member or friend. This includes the home medicine cabinet. A recent study found most American teenagers who abused prescription painkillers began taking the …

› Verified 5 days ago

› Url: https://www.premera.com/wa/visitor/healthsource/community/dispose-prescription-drugs/ Go Now

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Drugs Requiring Approval Producer Premera Blue Cross

Details: Drugs Requiring Approval. The Pharmacy Pre-approval Program includes four types of reviews: You can use our Rx Search tool to see if a drug falls into one or more of these categories. To request a review, the pharmacy or the provider needs to contact our Pharmacy Services Center at 888-261-1756 or fax in a drug-specific online form (see Pre

› Verified 8 days ago

› Url: https://www.premera.com/ak/producer/pharmacy/understanding-your-benefits/drugs-requiring-approval/ Go Now

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Drug Search AON Exchange Premera Blue Cross

Details: Drug Search. Use this tool to get information about prescription drugs, including how a drug may be covered and alternate drugs you can choose from. This tool provides general information to help you understand your plan and alternate drug choices. It is NOT a confirmation of coverage.

› Verified 8 days ago

› Url: https://www.premera.com/aonexchange/drug-search/ Go Now

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Prior Authorization for Infusion Drugs Based on Site of

Details: The following drugs will require prior authorization for site of service: As noted above, these drugs will have clinical prior authorization added to ensure use is for FDA-approved indications. Exondys 51 already has this prior authorization requirement. The clinical prior authorization criteria apply to all patients, according to medical

› Verified 5 days ago

› Url: https://www.premera.com/wa/provider/news/pharmacy/prior-authorization-infusion-drugs/ Go Now

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Generics Only (G1) Formulary List of Covered Drugs (Formulary)

Details: selects drugs for coverage based on each drugs safety, effectiveness and cost. The committee meets at least quarterly to review new drugs to market to determine placement on this list and also reviews updates safety, effectiveness and cost information for existing drugs to ensure the formulary remains up to date with current medical evidence.

› Verified 4 days ago

› Url: https://www.premera.com/documents/052151.pdf Go Now

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Formulary (List of covered drugs)

Details: The following drugs will be removed from the Premera Blue Cross Medicare Advantage . HMO, Classic (HMO), Classic Plus (HMO), Core (HMO), Core Plus (HMO), Total Health (HMO), Peak + Rx (HMO), Sound + Rx (HMO) and Charter + Rx (HMO) Formulary. Name of Affected Drug Reason for Change

› Verified 9 days ago

› Url: https://www.premera.com/documents/047755_2020.pdf Go Now

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New Preventive Drug Lists Are Available Employer

Details: Certain mental health drugs, osteoporosis therapy, asthma inhalers, and insulin products are now covered under our three standard preventive drug lists: PV Lite, PV Core, and PV Core Plus. This means that these drugs are now provided to our members at no cost share. Our newly updated standard preventive drug lists are as follows:

› Verified 2 days ago

› Url: https://www.premera.com/wa/employer/news/pharmacy/preventive-drug-lists/ Go Now

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Premera Blue Cross Visitor

Details: Visit Premera Facebook page Visit Premera Twitter page Visit Premera Youtube page Visit Premera LinkedIn page

› Verified 6 days ago

› Url: https://www.premera.com/visitor/drugs-requiring-approval Go Now

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2022 Summary of Benefits

Details: prescription drugs except for drugs listed on Tier 1 and Tier 2, which are excluded from the deductible. No deductible. No deductible. Maximum Out-of-Pocket Responsibility (does not include prescription drugs) You pay no more than $6,500 annually. Includes copays and other costs for medical services for the year. You pay no more than $5,000

› Verified 9 days ago

› Url: https://www.premera.com/documents/037040_2022.pdf Go Now

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2022 Formulary premera.com/ma

Details: The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, “Cardiovascular”. If you know what your

› Verified 9 days ago

› Url: https://www.premera.com/documents/027877_2022.pdf Go Now

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2021 Essentials Drug Exclusion List Provider Premera

Details: As a result, some drugs have been added to the Essential Drug List Exclusion List starting January 1, 2021. These include: High-cost drugs with lower-cost prescription alternatives. Drugs with lower-cost, over-the-counter alternatives. Brand-name drugs with lower-cost competing brand name alternatives. A letter was sent to affected members on

› Verified 1 days ago

› Url: https://www.premera.com/wa/provider/news/pharmacy/essentials-drug-exclusion-list/ Go Now

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2020 Essentials Drug Exclusion List Is Available

Details: As a result, some drugs have been added to the Essentials Drug List Exclusion List starting January 1, 2020. These include: High-cost drugs with lower-cost prescription alternatives. Drugs with lower-cost over-the-counter alternatives. Brand name drugs with lower-cost competing brand name alternatives. A letter was sent to affected members on

› Verified 1 days ago

› Url: https://www.premera.com/wa/provider/news/pharmacy/essentials-drug-list/ Go Now

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Select (C4) List of Covered Drugs (Formulary)

Details: selects drugs for coverage based on each drugs safety, effectiveness and cost. The committee meets at least quarterly to review new drugs to market to determine placement on this list and also reviews updates safety, effectiveness and cost information for existing drugs to ensure the formulary remains up to date with current medical evidence.

› Verified 4 days ago

› Url: https://www.premera.com/documents/052150.pdf Go Now

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5.01.540 Miscellaneous Oncology Drugs

Details: Chemotherapy drugs can be used in many different ways. Chemo can make a tumor smaller before surgery or radiation, destroy cancer cells that surgery or radiation didn’t treat, help other treatments work better, or kill cancer cells that have come back or spread. Chemotherapy is given in different ways.

› Verified 3 days ago

› Url: https://www.premera.com/medicalpolicies-individual/5.01.540.pdf Go Now

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Changes to 2022 Essential Drug Exclusion List Provider

Details: As a result, some drugs will change preferred status and some drugs have been added to the Essential Drug Exclusion List starting January 1, 2022. Formulary exclusions include: High-cost drugs with lower-cost prescription alternatives. Drugs with lower-cost, over-the-counter alternatives.

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Updates for Office Administered Drugs and Multiple

Details: These drugs are submitted under a member’s medical benefits utilizing either a J-series or Q-series HCPCS code. The edits being implemented are based on criteria that are listed in the Federal Drug Administration package inserts for the drugs such as but not limited to age limits, treatment contraindications, and dosage maximums/minimums.

› Verified 5 days ago

› Url: https://www.premera.com/wa/provider/news/reminders-updates/office-administered-drugs/ Go Now

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5.01.603 Epidermal Growth Factor Receptor (EGFR) Inhibitors

Details: Injectable drugs listed in policy may be approved up to 6 months. Re-authorization criteria Future re-authorization of oral and injectable drugs may be approved up to 12 months as long as the drug-specific coverage criteria are met and chart notes demonstrate that the

› Verified 2 days ago

› Url: https://www.premera.com/medicalpolicies/5.01.603.pdf Go Now

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HSP Preventive Drug List Microsoft

Details: Prescription drugs The following drugs are considered preventive care and are covered at 100 percent by the plan without being subject to the deductible. This list represents certain common single-source brand and generic preventive medications that are covered in …

› Verified 4 days ago

› Url: https://www.premera.com/documents/022506.pdf Go Now

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Pharmacy Benefit Guide Provider Premera Blue Cross

Details: Preventive Drugs - Certain generic preventive drugs will have a very low or no cost share. Who decides a drug's value? A drug's value is based on science. An independent set of experts made up of leading physicians, pharmacists, health economists, a bioethicist, and a …

› Verified 6 days ago

› Url: https://www.premera.com/ak/provider/pharmacy/understanding-your-benefits/pharmacy-benefit-guide/ Go Now

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Drug List Changes Producer Premera Blue Cross Blue

Details: *These drugs have been selected by an independent group of experts made up of doctors and pharmacists. This group reviews drugs to see how well they work relative to their cost. They also compare their effectiveness to similar drugs used to treat the same condition. Please talk with your doctor to see if these new options are right for you.

› Verified 4 days ago

› Url: https://www.premera.com/ak/producer/pharmacy/drug-search/upcoming-formulary-changes/ Go Now

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2020 Essentials Drug Exclusion List Is Available

Details: Drugs with lower-cost over-the-counter alternatives; Brand name drugs with lower-cost competing brand name alternatives; A letter was sent to affected members on November 18 and asked them to contact their provider about alternative treatments. All excluded drugs have a therapeutic alternative. In some cases, an over-the-counter (OTC) drug may

› Verified 1 days ago

› Url: https://www.premera.com/ak/provider/news/pharmacy/essentials-drug-list/ Go Now

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5.01.576 Drugs for Rare Diseases

Details: specified drugs. Hospital-based outpatient setting • Outpatient hospital IV infusion department • Hospital-based outpatient clinical level of care IV infusion therapy of various medical or biologic agents will be covered in the most appropriate, safe and cost-effective site. This site is considered medically necessary for the first 90 days

› Verified 2 days ago

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Glossary Provider Premera Blue Cross

Details: Formulary - A listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given managed population and that are to be used by a health plan's providers in prescribing medications. A formulary is also sometimes called a preferred drug list. A formulary may exclude certain drugs from coverage.

› Verified 1 days ago

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Our Preventive Drug List is Changing Employer Premera

Details: Our Preventive Drug List is Changing. As small groups renew in 2022, certain mental health drugs, osteoporosis therapy, asthma inhalers, and insulin products will be covered under the PV Core drug list replacing PV1. This will be the standard option for fully insured group plans. In addition to the minimum required preventive drugs, this list

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Medicare Advantage Part B Specialty Drugs May Require Step

Details: Drugs requiring step therapy are listed on the prior authorization list. For drugs requiring step therapy, authorization request questions will be different from the ones you currently answer. Here are some examples of drugs that require step therapy: Botox ® for migraines and over active bladder

› Verified 3 days ago

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5.01.546 Medical Necessity Criteria for Compounded …

Details: Initial authorization Compound drugs may be approved up to 12 months. Re-authorization criteria Future re-authorization of compound drugs may be approved up to 12 months as long as the drug-specific coverage criteria are met and chart notes demonstrate that the patient continues to show a positive clinical response to therapy.

› Verified 2 days ago

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Immunodeficiency and Immune Disorders

Details: D84.821 Immunodeficiency due to drugs Medications that interfere with the immune system. These medications include immunosuppressants, corticosteroids, and chemotherapy. D84.822 Immunodeficiency due to external causes Caused by external factors such as exposure to radiation therapy or due to transplant status.

› Verified 4 days ago

› Url: https://www.premera.com/documents/054524.pdf Go Now

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New Preventive Drug Lists Are Available Producer

Details: Certain mental health drugs, osteoporosis therapy, asthma inhalers, and insulin products are now covered under our three standard preventive drug lists: PV Lite, PV Core, and PV Core Plus. This means that these drugs are now provided to our members at no cost share. Our newly updated standard preventive drug lists are as follows:

› Verified 2 days ago

› Url: https://www.premera.com/ak/producer/news/pharmacy/preventive-drug-lists/ Go Now

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5.01.549 Off-Label Use of Drugs and Biologic Agents

Details: The NCCN Drugs and Biologics Compendium is based directly on the NCCN Clinical Practice Guidelines in Oncology. The compendium lists specific panel recommendations for off -label uses of drugs, and each recommendation is supported by a level of evidence category. The NCCN Categories of Evidence and Consensus used in the recommendations are:

› Verified 3 days ago

› Url: https://www.premera.com/medicalpolicies-individual/5.01.549.pdf Go Now

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HEDIS Quality Measure: Statin Therapy Provider Premera

Details: What is HEDIS Statin Therapy measuring? This measure examines the percentage of males 21–75 years of age and females 40–75 years of age who were identified as having clinical ASCVD and met the following criteria: Members who were dispensed at least one high-intensity or moderate-intensity statin medication during the measurement year

› Verified 9 days ago

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Mandatory Specialty Drug List

Details: *Drugs with an asterisk are normally administered in a clinic, infusion center or provided by home infusion services, and therefore are generally covered under the medical benefit, not the pharmacy benefit. They may also require prior authorization. Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association 017542

› Verified 5 days ago

› Url: https://www.premera.com/documents/017542_TaglinePBC.pdf Go Now

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Prior Authorization for Infusion Drugs Based on Site of

Details: As noted above, these drugs will have clinical prior authorization added to ensure use is for FDA-approved indications. Exondys 51 already has this prior authorization requirement. The clinical prior authorization criteria apply to all patients, according to medical policy criteria.

› Verified 5 days ago

› Url: https://www.premera.com/ak/provider/news/pharmacy/prior-authorization-infusion-drugs/ Go Now

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5.01.572 Coverage Criteria of Excluded Drugs for

Details: drugs. Formulary drug: A formulary drug (also known as a preferred drug) is a drug that is on the formulary list. Drugs that are not on the list are referred to as nonformulary drugs, or as in the case of this policy, those could be referred to as “excluded” drugs. Generic equivalent: When the original patent on a brand name drug expires, other

› Verified 2 days ago

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Disease-Modifying Anti-Rheumatic Drug Therapy for

Details: occurs more often in women and older people. i Disease modifying anti -rheumatic drugs (DMARDs) can help preserve joint function and prevent further damage to joints. ii APPLICABLE LINES OF BUSINESS • Medicare Advantage . MEASURE DESCRIPTION . Percentage of patients 18 years of age and older who were diagnosed with Rheumatoid Arthritis (RA) and

› Verified 4 days ago

› Url: https://www.premera.com/documents/046054.pdf Go Now

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