Pharmacy Programs

The Prior Authorization and Step Therapy programs encourage safe, cost-effective medication use. These programs may be part of your prescription drug benefits. Refer to your benefit materials to find out if your benefit plan has these programs, as well as which medications are part of your plan.

Prior Authorization

This program requires your doctor to request pre-approval, or prior authorization, for you to get benefits for select medications.

• Your prescription drug benefits may have drug categories and specific drugs that require prior authorization.
• Some of those drug categories and examples of medications are listed below. Not all drug categories are included in your benefit plan. Additional drug categories may be added throughout the year.
  • Prior Authorization Program for Members on a “Metallic” Health Plan
  • Prior Authorization Program for Members on the Basic or Enhanced Drug Lists
  • Prior Authorization Program for Members on the Balanced Drug List
  • Prior Authorization Program for Members on the Performance Drug List
  • Prior Authorization Program for Members on the Performance Select Drug List
• Your doctor can find request forms at bcbsok.com/provider.
• As always, cost is only one factor in choosing medication. Treatment decisions are between you and your doctor.
• Review the member flier for more information about Prior Authorization.
• Call the number on your member card with questions about a specific medication.
   

Step Therapy

The Step Therapy program requires that you use a “preferred” medication before your benefit plan will cover a “non-preferred” medication. The preferred medication is safe, works well in treating a specific medical condition, and is a cost-effective treatment option. A non-preferred medication could be a more costly prescription.

Step 1: If possible, your doctor should prescribe a preferred medication that is right for your condition.

Step 2: If you and your doctor decide that a preferred medication is not right for you, or is not as good in treating your condition, your doctor should submit a step-therapy exception to cover the non-preferred medication. Your doctor can find these request forms at bcbsok.com/provider.

• The drug categories and examples of medications are listed below. Not all drug categories are included in your benefit plan. Additional categories may be added.
  • Step Therapy Programs for Members on a "Metallic" Health Plan
  • Step Therapy Programs for Members on the Basic or Enhanced Drug Lists
  • Step Therapy Programs for Members on the Balanced Drug List
  • Step Therapy Programs for Members on the Performance Drug List
  • Step Therapy Programs for Members on the Performance Select Drug List

• As always, cost is only one factor in choosing medication. Treatment decisions are between you and your doctor.
• Download the member flier for more information about Step Therapy.

• Call the number on your member card with questions about a specific medication.

If you have questions about either the prior authorization or the step therapy programs, call the number listed on your member card.

Specialty medications are those used to treat serious or chronic conditions. Examples include hepatitis C, hemophilia, cancer and multiple sclerosis. They often require careful adherence to treatment plans, have special handling or storage needs, and may only be stocked by select pharmacies. See the specialty pharmacy program member flier  for more information.

You can download the  Specialty Pharmacy Program Drug List  which includes a reminder about coverage for self-administered specialty medications.

A split fill program may apply to some medications like select oral oncology (cancer), multiple sclerosis and iron toxicity drugs. This program lets you try the medication first to make sure you can tolerate any potential side effects. You will get a partial fill of your prescription and only pay for what was filled (a prorated cost of your benefits).

Coverage benefits and requirements may vary based on your plan benefits. Call the number on your member ID card if you have any questions.

Home delivery (mail order) service pharmacy for members with BCBSOK prescription drug coverage, provides safe, fast and cost-effective pharmacy services that can save you time and money. You can obtain up to a 90-day supply of long-term (or maintenance) medications. Maintenance medications are those drugs you may take on an ongoing basis to treat conditions such as high cholesterol, high blood pressure or diabetes.

Download the maintenance drug list to check if your medication is included.

Ordering Through Home Delivery Service Pharmacy

You can get up to a 90-day supply of long-term (or maintenance) medicine through a network of retail or home delivery service pharmacies. How much you pay will be based on the medicine and your benefit plan.

• Visit bcbsok.com or myprime.com  to find an in-network retail or home delivery service pharmacy convenient for you. Log in to Blue Access for Members^SM and click on Prescription Drugs in the Quick Links section. Then select Find a Pharmacy.

More information is available in the home delivery (mail order) member flier.

If you have coverage through Blue Cross and Blue Shield of Oklahoma, vaccinations may be covered under the medical benefit or the prescription drug benefit, based on your plan. Select vaccines can be conveniently administered at a pharmacy near you. These vaccines can help protect you from illnesses such as the flu, pneumonia, shingles, hepatitis B, meningitis, HPV, tetanus, diphtheria and pertussis.

To learn more about which vaccines are available under your plan for you and your covered family members, check your benefit materials for details and any necessary copays. 

• For vaccinations covered under the prescription drug benefit, select vaccines can be conveniently administered at a participating vaccine network pharmacy near you. Just hand your ID card to the pharmacist.
• To see a complete list of all participating pharmacies, search the pharmacy network on myprime.com and filter for vaccine pharmacies. 
• Before you go, be sure to confirm the location's participation and hours, vaccine availability and ask about any other age limits, restrictions or requirements that may apply.

More information is available in the  pharmacy vaccine program member flier.

If you have BCBSOK prescription drug benefit coverage, you have access to our team of clinical pharmacists and other resource tools to help answer questions you may have about your prescriptions.

The Pharmaceutical Care Management (PCM) program helps you get the best results from the medicines you take. A member of the PCM team may reach out to talk with you about the medicines you take. The medication review by a clinical pharmacist helps make sure the medicines you are taking are safe and work well. The pharmacist can also share ways to help you lower your out-of-pocket costs for your prescriptions.

For more information about how PCM works:

• Download the  PCM Program member flier.