Medical drugs requiring prior authorization (CareFirst CHPMD)
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This document lists medical drugs that require prior authorization from CareFirst BlueCross BlueShield Community Health Plan Maryland and governs providers submitting medical drug requests to the plan.
No material clinical or coverage changes in this revision.
Prior Authorization Requirements
Prior authorization stance
Drugs listed require prior authorization from CareFirst CHPMD; additions and removals may occur at any time.
Clinical or quantity criteria are not included in this excerpt; contact the plan for submission requirements.
Representative HCPCS / J-Codes
What Providers Must Do
Prior authorization required; list may change
Prior authorization is required for the medical drugs listed in this document effective 10/1/25. CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) may add or remove drugs from its medical drug prior authorization list at any time to encourage utilization of clinically appropriate and lower net cost products or to comply with state guidance.
Provider help and phone lines for authorization or service needs
For help with authorizations or other service needs, providers should call the Provider Line and follow the voice prompts for the option that addresses their request. General help and translator services are also available via the phone numbers listed.
- General/help/translator: 410-779-9369 or 800-730-8530
- Provider Line for service needs: 410-779-9359 or 800-730-8543 (follow voice prompts)
Key Terms and List
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.