CurrentBlue Cross Blue Shield - New MexicoPolicy N/A

Step Therapy Program

Lists drug categories and example medications that are subject to step therapy programs under the payer's prescription drug benefit. Indicates that programs may change and that members/providers can request an exception review via the phone number on the member ID or the provider website.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyStep Therapy Program

Policy CodePolicy N/A

Change Typeclarified

Effective Date

Next Review Date

Key ActionIf the prescribed drug is not on the member's allowed step or requires prior steps, the member or prescribing provider may request an exception review by calling the number on the Member ID card or via bcbsnm.com/provider; the member may need to meet the drug's step therapy criteria as part of the review.

SourceLink

POLICY UPDATE CHANGES

Lists example drugs within categories that may be included in the step therapy program (Performance Drug List).

9Drug categories listed

multipleExample medications

Summary of Changes

This bulletin clarifies that the document provides illustrative brand and generic examples across multiple drug categories that may be subject to step therapy on the Performance Drug List, including atopic dermatitis, atypical antipsychotics, depression, gabapentin ER, insomnia, Kerendia category, and topical NSAIDs. The examples shown are illustrative and the programs and listed drugs may change from time to time.

Policy metadata

Policy TitleStep Therapy Program - Performance Drug List

PayerBlue Cross Blue Shield - New Mexico

StatusCURRENT

Scope summaryLists drug categories and example medications that are subject to step therapy programs under the payer's prescription drug benefit. Indicates that programs may change and that members/providers can request an exception review via the phone number on the member ID or the provider website.

Change typeclarified