Prior Authorization/Step Therapy Criteria

Medicare Advantage members need prior authorization for these drugs. If you have prescribed or are prescribing one of these drugs for a Medicare Advantage member, call Caremark's Prior Authorization department at 1-800-294-5979. Caremark is an independent company that provides pharmacy benefits management on behalf of BlueCross.

View the Prior Authorization Criteria drug list.

View the Step Therapy Criteria drug list.

Prior Authorization Fax Forms

You can also download, print and fax forms for these drugs to Caremark at 1-855-633-7673.

Adcirca   Agrylin   Ampyra   Anabolic Steroids   Avonex   Boniva   Brilinta   Buprenorphine   Butisol   Bydureon   Byetta   Calcitriol   Canitor   Celebrex   Chantix   Copaxone   Desferal   Duragesic   Emend   Enbrel   Epoetin Alfa   ESRD Heparin and Lidocaine   Forteo   Gilenya   Gleevec   Hectorol   High-Risk Medication   Humira   Immunosuppressants   Injectables B vs. D   Letairis   Lidoderm   Miacalcin Injection   Neudexta  
Non-Formulary Exception   Oral Chemo   Pamidronate   Provigil   Quantity Limits Exception   Ranexa   Remicade   Revatio   Revlimid   Risperdal Consta   Stivarga   Symlin   Tarceva   Tobi Inhalation   Zemplar   Zytiga