2026 Drug List
Part 1 of Blue Cross Blue Shield Oklahoma's 2026 Drug List formulary describing general formulary policies, tier definitions, coverage considerations, exception process, specialty drug notes, and the first sections of the therapeutic class drug listing (anti-infectives through select antivirals). Governs pharmacy benefit tiers, special requirements (PA, ST, QL, AC, SP), dispensing limits and exception/appeal timelines.
No material clinical/coverage changes — has_material_change=false in brief.
2026 Drug List — Part (extract)
Coverage rules, requirements, and definitions
Exception Process / Prior Authorization / Expedited Review
- A prior authorization (PA) is required when noted with 'PA' in the Special Requirements column; providers must submit a PA request before the medication will be covered.
Operational: submit via the payer portal or by phone per member ID card instructions.
- Standard PA review timeline: decisions are rendered within 14 calendar days of receipt of a complete request.
If incomplete, the requestor will be notified and the clock is paused until information is received.
- Expedited (urgent) review: requests that meet the clinical definition of urgency (serious risk to health, ability to regain function, or intense pain) will be expedited and decided within 72 hours of receipt of a complete request.
Providers should clearly indicate 'expedited' and the clinical rationale on submission.
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