Pharmacy

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.

Drug Authorization Form

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

Open and Covered Drug Lists

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.

EVICORE PORTAL FOR ELECTRONIC SUBMISSION OF MEDICAL DRUG AUTHORIZATIONS
On December 2, 2024, and after, providers must use the EviCore provider portal for electronic submissions for medical drugs. For information on using the EviCore provider portal, training opportunities or support, please view the frequently asked questions (FAQ) and training presentation below.

Electronic Submission Portal Change for Medical Drug Authorizations FAQs

Electronic Submission Portal Change for Medical Drug Authorizations Webinar