Drugs Requiring Prior Approval
Drugs requiring prior approval have detailed criteria that must be met before prior authorization can be granted. The chart below contains:
- Drugs requiring prior authorization
- The prior authorization policies
- Member information regarding the drug listed
If the drug you are looking for is not listed in the chart below, please check Drugs Requiring Step Therapy and Drugs Subject to Quantity Limits.
Pharmacy Policy Update Notifications - Please note the draft policies are highlighted below with effective dates. Any provider comments on the policies should be sent 30 days prior to the effective date. Send them to pharmacycomments@shpnc.org.
TO INITIATE A COVERAGE REVIEW, providers should visit www.medco.com/coverage or call 800-753-2851.
*These drugs may be covered under the pharmacy or medical benefit. If it is covered under the pharmacy benefit, contact Medco for prior approval. If it is covered under the medical benefit, contact Blue Cross and Blue Shield of North Carolina for approval.
