Step Therapy Programs for Members on the Balanced Biosimilar Drug List
Defines categories of prescription drugs subject to step therapy requirements for members whose benefits include the Balanced Biosimilar Drug List; applies to Blue Cross Blue Shield - Oklahoma members and their prescribing providers.
No material clinical or coverage changes in this revision.
Coverage Criteria
If a medication is not included on the payer's Drug List, the member or the prescribing provider may request an exception review. During the exception review the member may be required to demonstrate that the drug's step therapy program criteria have been met before the exception request can be approved. To initiate an exception review, call the number on the member's ID card or ask the provider to submit the request via bcbsok.com/provider.
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