Step Therapy Programs for Members on the Balanced Biosimilar Drug List
Defines step therapy programs and example drug categories included on the Balanced Biosimilar Drug List for Blue Cross Blue Shield - New Mexico members; informs members and providers about exception review process and contact methods.
No material clinical or coverage changes in this revision.
Coverage Criteria Overview
This document does not list specific coverage criteria. Programs are subject to change, and additional drugs may be added to the categories shown on the Balanced Biosimilar Drug List. The examples provided are illustrative and do not constitute a complete or permanent list of medications subject to step therapy.
Provider and Member Actions
Step therapy applies to listed categories
Some drugs on the Balanced Biosimilar Drug List may require completion of an established step therapy program before coverage is approved. Examples of affected drug categories include atypical antipsychotics, antidepressants, gabapentin ER products, Kerendia, and topical NSAIDs; this is not an exhaustive list and categories may change.
- Examples of categories with step therapy programs: atypical antipsychotics; depression/antidepressants; gabapentin ER products; Kerendia; topical NSAIDs.
- If a member's prescribed drug is not on the Drug List, an exception review can be requested.
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