Summer 2009

Prior authorization, Responsbile Quantity programs add new medications

Effective July 1, 2009, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) and Health Options, Inc. will implement two pharmacy program changes involving prior authorization and the Responsible Quantity program.

The following medications will require a prior authorization for coverage: Lamisil, Nuvigil, Penlac, Provigil, Sporanox and Xyrem. The change is designed to ensure usage that meets drug manufacturers’ and Food and Drug Administration’s (FDA) approved label indications. The Prior Authorization drug table and forms are available on our website, www.bcbsfl.com. Under Physicians & Providers, click on Pharmacy, then Prior Authorization Program Information and Authorization Forms.

The Responsible Quantity program ensures coverage of certain prescription drugs reflects drug manufacturers’ and FDA’s dosing guidelines. Medications and limits are being added to the Responsible Quantity program for BlueCare, BlueChoice, BlueOptions and BlueSelect members. For the Responsible Quantity drug table, go to www.bcbsfl.com and click on Physicians & Providers, Pharmacy, then Responsible Quantity. Also on the Pharmacy page is the Quantity Limit Authorization form, which should be used if additional quantities are required.