Step Therapy Programs for Members on the Balanced Biosimilar Drug List
Describes step therapy programs applying to members whose prescription drug benefits include the Balanced Biosimilar Drug List; affects prescribing providers and members covered by Blue Cross Blue Shield - Oklahoma prescription drug plans.
No material clinical or coverage changes in this revision.
Coverage Criteria
This policy does not list any explicit exclusions. It states that the examples provided are not exhaustive and that additional drugs may be added to the categories subject to step therapy on the plan's Drug List. When a drug is not included on the Drug List, an exception review is available to determine coverage.
Provider Actions & Requirements
Prior Authorization / Step Therapy Notice
Some drugs listed as examples may be subject to a step therapy program and may require completion of prior step(s) or an exception review before coverage is approved. To initiate an exception review, call the number on the member's ID card or have the prescribing provider submit a request via bcbsok.com/provider.
- Contact: number on member ID card or bcbsok.com/provider
Step Therapy Categories (examples)
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