We do not reimburse providers for certain self-administered medications when obtained from a non-retail pharmacy provider. Only drugs associated with excluded drug codes are not payable to provider. Physicians may continue to buy and bill all other medications.
Codes of Self-Administered Drugs Only Covered Under the Pharmacy Benefit
PHARMACY AUTHORIZATIONS & FORMULARY EXCEPTIONS
Authorizations for targeted medications, Step Therapy medications and formulary exception requests must be requested directly from Express Scripts, Inc., (ESI); our pharmacy benefits manager.
Fax completed forms to 1-877-251-5896.
You may request authorizations directly from ESI by calling 1-800-842-2015.
When contacting ESI for physician buy & bill, please have all codes you will be billing to Blue Cross ready when contacting ESI. It is imperative that these codes are captured by ESI to ensure appropriate reimbursement.
OTHER DRUG RESOURCES & POLICIES
Quantity Per Dispensing (QPD) Level Limits/Allowances
Specialty Pharmacy Program Drug List
Note: On behalf of Blue Cross and Blue Shield of Louisiana, prior authorizations are administered by Express Scripts, Inc., an independent pharmacy benefit management company. Please note that the authorization is not a guarantee of payment. Payment is subject to the member's eligibility, benefits and pre-existing condition limitations at the time the services are provided. We recommend you contact BCBSLA at 1.800.922.8866 to verify benefits.