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Blue Care Network

Request Prescription Drug Coverage

If a medication requires step-therapy or prior authorization, and your BCN patient does not meet our criteria, you can request coverage based on medical necessity. You can also ask BCN to waive quantity restrictions if the quantity allowed is not appropriate based on the member's condition.

Most BCN members do not have coverage for nonformulary drugs. Please use our Benefit Exception Form to request coverage for a nonformulary drug when a formulary alternative will not work or it has the potential to cause the member an adverse event.

Generally, BCN will only approve your request for an exception if the alternative drugs included on the plan's formulary would not be as effective and/or would cause the member to have adverse medical effects. There are two ways to request coverage:

• Contact the BCN Clinical Pharmacy Help Desk at
  1-800-437-3803 to initiate a prior authorization request.
• Complete the appropriate Benefit Exception or Medication Request Form located on web-DENIS > BCN Provider Publications and Resources > Forms. Fax completed forms to the BCN Clinical Pharmacy Help Desk at 1-877-442-3778. If you need to send an attachment, please fax the attachment with the form.