New Case Review Process for HIT Providers Dispensing Hemophilia Medications
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”) is continually working with healthcare delivery partners to optimize UM strategies to increase efficiencies and control costs while ensuring members receive affordable, quality care.
Effective May 15, 2024, Home Infusion Therapy (HIT) providers will need to submit a prior authorization for hemophilia medications for all Commercial lines of business including CareFirst PPO, Indemnity, BlueChoice, HealthyBlue, NASCO, and BlueCard. This is part of a Hemophilia Management Program that is administered by CVS/Caremark, which also includes a case review before dispensing medication.
For FEP: Prior authorization for FEP is not required as the drugs on the current list are already approved for these members.
Important Note: This program is mandatory and must be followed to prevent claims from denying for not having an authorization.
What is the process?
Important Note: Once your authorization has been approved, then you must complete the Hemophilia Case Review process. A Hemophilia Case Review must be completed prior to dispensing hemophilia medication.
- The dispensing provider must submit/fax clinical data using the CVS/Caremark Hemophilia Case Review Form to 866-541-2934.
- CVS/Caremark will review the request to verify clinical accuracy and dosage.
- CVS/Caremark will fax notification back to the provider within one business day, advising if the review is approved and the approved quantity to be dispensed.
For emergent orders requiring an expedited review, follow the above process and call CVS/Caremark at 800-541-2934.
The CVS/Caremark Case Review Team is available 24/7 for questions or concerns at 800-541-2934.