Medical Preferred Drug Strategy Update: January 1, 2022
Effective January 1, 2022, CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. and their subsidiaries and affiliates (CareFirst) will update its preferencing strategy for select medications covered under the medical benefit. When medically appropriate, the preferred medications will need to be tried first before a non-preferred medication can be covered.
Why the change?
CareFirst’s Medical Preferred Drug Strategy supports utilization of preferred medications which are equally safe and clinically effective as non-preferred medications and leverages lower drug costs associated with biosimilar therapies to manage cost.
What does this mean for impacted patients?
- If a patient is taking a non-preferred medication, they can continue to take that medication until the current prior authorization expires.
- If a patient needs to continue medication therapy with the non-preferred medication, you can submit a new prior authorization upon the expiration date of the current prior authorization.
- The new prior authorization may result in an approval for an alternative, preferred medication, which is as clinically effective and safe as the non-preferred medication.
- If you believe the non-preferred medication must be continued, you may submit information within the new prior authorization request to obtain a medical necessity exception.
How do I request prior authorization?
Providers may submit a prior authorization for Commercial, Individual and Group Medicare Advantage members online by logging in to the Provider Portal at carefirst.com/providerlogin and navigating to the Pre-Auth/Notifications tab.
CareFirst BlueCross BlueShield Advantage DualPrime (HMO-SNP) providers may submit a prior authorization on behalf of members by going to carefirstmddsnp.com/for-providers and selecting the Medical Injection Preauthorization Request Form. Please fax the completed form, along with any supporting documentation, to 844-329-0865.
Preferred Drug Strategy Drug List
To compare the strategy changes, review the 2021 and 2022 drug lists below: