BlueCross BlueShield of South Carolina

Prior Authorization/Step Therapy Forms

Some prescription drugs require approvals before you can take them. Here is a list of prior authorization/step therapy drugs for Medicare Blue^SM (PPO) or Medicare Blue^SM Plus (PPO) members. You can click on the name of the medication and print the attached authorization form. Ask your provider to complete the form and fax it to the Prior Authorizations department at 1-888-836-0730.

Drugs with an asterisk are only included on the Medicare Blue Plus (PPO) plan. All other drugs apply to both Medicare Blue (PPO) and Medicare Blue Plus (PPO).

Prior Authorization Criteria

Cost-Sharing Tier 4

Step Therapy Criteria

Cost-Sharing Tier 4

Last updated: 9/1/10
MOO54_WBPPO10 (02/2010)