CurrentBlue Cross Blue Shield - OklahomaPolicy N/A

Step Therapy Programs for Members on the Oklahoma Performance Full Drug List

Describes step therapy programs applied to multiple prescription drug categories on the Oklahoma Performance Full Drug List and explains exception review process for drugs not on the list. Lists example drugs within categories subject to step therapy.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyStep Therapy Programs for Members on the Oklahoma Performance Full Drug List

Policy CodePolicy N/A

Change TypeClarified (examples listed; list subject to change)

Effective Date

Next Review Date

Key ActionIf the drug is not on the Drug List, the member or prescribing provider must request an exception review and may be required to meet step therapy program criteria; initiate by calling the number on the Member ID card or via bcbsok.com/provider.

POLICY UPDATE CHANGES

Lists example drugs by therapeutic category that may be subject to step therapy on the Oklahoma Performance Full Drug List.

6Therapeutic categories listed (examples)

Summary of changes and scope

This bulletin notifies members and providers that step therapy programs apply to drugs on the Oklahoma Performance Full Drug List. Example therapeutic categories subject to step therapy include Atopic Dermatitis, Atypical Antipsychotics, Depression, Gabapentin ER, and Kerendia. Third-party brand names are acknowledged and are the property of their respective owners. These lists and programs are subject to change and additional drugs may be added.

Key facts

SubjectStep Therapy Programs for Oklahoma Performance Full Drug List

ScopeDescribes step therapy programs applied to multiple prescription drug categories on the Oklahoma Performance Full Drug List and explains exception review process for drugs not on the list. Lists example drugs within categories subject to step therapy.

Therapeutic categories listed (examples)6

Has material changefalse

Step therapy applicability and exception review

Step Therapy Applicability / Exception Review

Step therapy programs may be included as part of the prescription drug benefit plan; exception requests available when drug is not on list:

ALL of the following

Drug is included in the Oklahoma Performance Full Drug List categories subject to step therapy (examples listed in document).
If a drug is not on the Drug List, the member or prescribing provider can request an exception review.
As part of an exception review, the requestor may need to meet the drug's step therapy program criteria before approval.
To start the review, call the number on the Member ID card or have the doctor visit bcbsok.com/provider.

What providers and members must do

Step Therapy

Exception review required for non-listed drugs / step therapy adherence

If the drug is not on the Oklahoma Performance Full Drug List, the member or prescribing provider must request an exception review and may be required to meet step therapy program criteria. Initiate the review by calling the number on the Member ID card or by visiting bcbsok.com/provider.

Call number on Member ID card
Visit bcbsok.com/provider

Document changes and examples

Provides multiple example categories and medications that may be subject to step therapy (Atopic Dermatitis, Atypical Antipsychotics, Depression, Gabapentin ER, Kerendia) and notes that the list of drugs is subject to change and additional drugs may be added.

clarifiedLatest

Lists example drugs by therapeutic category that may be subject to step therapy on the Oklahoma Performance Full Drug List.

Effective dates and next steps

Note

Initiate exception reviews / step therapy — programs and lists may change

Start an exception review or prior authorization for drugs potentially subject to step therapy by contacting the number on the Member ID card or using the provider portal. Note: these programs and the lists of drugs may change and additional drugs may be added.

Start review by calling number on Member ID card
Provider portal: bcbsok.com/provider

Dates

Effective dateEffective date: see payer communication

Last reviewsee payer communication

Next reviewsee payer communication