CurrentBlue Cross Blue Shield - New MexicoPolicy N/A

Prior Authorization Basic Enhanced Nm

Lists drug categories and specific prescription drugs that are subject to prior authorization for members on the Basic Drug List or Enhanced Drug List. The document enumerates many drug categories with associated brand/generic drugs but contains no explicit clinical criteria or billing codes.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyPrior Authorization Basic Enhanced Nm

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionProviders must obtain prior authorization for any drug listed under the Basic Drug List or Enhanced Drug List before dispensing; contact number is on the member ID card.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes identified in this update.

manyDrugs Listed

2Lists (Basic/Enhanced)

Coverage Summary & Scope

Lists drug categories and specific prescription drugs that are subject to prior authorization for members on the Basic Drug List or Enhanced Drug List for Blue Cross Blue Shield - New Mexico; it is presented as a master roster of categories and brand/generic agents. The provided document enumerates many categories and individual drugs but contains no explicit clinical criteria or billing codes in the text supplied.

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Prior Authorization Requirement

Drugs listed under the Basic Drug List or Enhanced Drug List require prior authorization for members.

Listed Drug: Drug is listed within a named category on the Basic Drug List or Enhanced Drug List (as enumerated in the policy).
See policy lists for specific categories and drugs.
Authorization Required: Prior authorization must be obtained prior to coverage/dispense for listed drugs.
Providers must obtain PA before dispensing; contact number on member ID card.

Enumerated Drug Categories and Agents

The policy enumerates numerous categories (for example: Actinic Keratosis agents, Acute Migraine agents, Afrezza, Amifampridine (Firdapse), multiple Biologic Immunomodulators including many adalimumab biosimilars and other branded biologics, Calcitonin Gene-Related Peptide (CGRP) agents such as Aimovig, Ajovy, Emgality, Nurtec ODT, Qulipta, Ubrelvy, Zavzpret, and an extensive roster of specialty and other agents). The document contains exhaustive lists of brand and generic names under each category that together form the roster of drugs requiring prior authorization.

Prior Authorization & Documentation Requirements

Prior Authorization

Prior Authorization Required

Providers must obtain prior authorization for any drug listed under the Basic Drug List or Enhanced Drug List before dispensing; contact number is on the member ID card.

Documentation Required

Reference Drug Name in PA Request

When requesting prior authorization, reference the specific drug or product name as listed in the policy (brand and generic names provided).

Policy Background & Definitions

This document is a master list of drug categories and associated brand/generic agents that are subject to prior authorization under Blue Cross Blue Shield - New Mexico's Basic and Enhanced Drug Lists. It functions as a reference roster; specific clinical coverage criteria, PA forms, or step-therapy rules are not included in the text provided.

Basic Drug List / Enhanced Drug List: Plan-specific formularies that categorize drugs subject to prior authorization; exact definitions and distinctions are not provided in this document.