• Pharmacy Directory
• Medicare Part D Prescription Drug Auth. Request Form
• BlueRx Summary of Benefits
• BlueRx Formulary I
• BlueRx Formulary II and III

• 2008 BlueAdvantage Formulary
• 2008 BlueAdvantage Pharmacy Directory

Formulary

See www.bcbst.com for the BlueAdvantage formulary

Prior Authorization

Certain drugs with special indications require authorization.  These drugs are noted on the formulary. The prescribing Practitioner is responsible for obtaining the necessary authorization from Preferred Care Services, Inc. (PCSI). Prior authorizations must be obtained before the drug is dispensed. Authorization requests must be submitted on the Medicare Part D Prescription Drug Authorization Form via fax to 1-205-220-9575.

Quantity Limits or Maximum Drug Limitation

Some medications have a quantity limit for a given time period.  These drugs are noted on the formulary.  Greater quantities require physician request for medical necessity by calling PCSI at 1-888-234-8253.

Appeals

If PCSI has made an adverse determination for a medication or pharmaceutical product, the member or the member’s physician may initiate a pharmacy appeal.  This appeal must be in writing to:

Part D Authorization Requests
Attn: Pharmacy Review
P.O. Box 12485
Birmingham, AL  35202-2485