Blue Cross and Blue Shield of Illinois' (BCBSIL) prior authorization/step therapy program is designed to encourage safe, cost-effective medication use. Most HMO groups include this program.

Prior Authorization

Under this part of the program, your physician will be required to obtain authorization from BCBSIL in order for you to receive benefits for certain medications and drug categories.

Below are drug categories and specific medications* for which a prior authorization program exists for most HMO members. Please note that the drug categories and medications may change from time to time. For the most up-to-date list, call the Pharmacy Program number on the back of your BCBSIL ID card.

As always, cost is only one factor in choosing medication, and treatment decisions are between you and your doctor.

Acne

• Solodyn

Anabolic steroids

• Anadrol-50
• Oxandrin
• Winstrol

Growth Hormones

• Genotropin
• Humatrope
• Norditropin
• Nutropin
• Nutropin AQ
• Omnitrope
• Saizen
• Serostim
• Tev-Tropin
• Zorbtive

Hepatitis C

• Infergen
• Pegasys
• PegIntron

Narcolepsy

• Nuvigil
• Provigil
• Xyrem

Oral Fentanyl

• Actiq
• Fentora
• Onsolis

Step Therapy

Step therapy is a type of prior authorization. In order for you to receive coverage for drugs included in this part of the program, your physician will be required to obtain authorization from BCBSIL.

As an alternative to asking your doctor to receive prior authorization, or paying the entire cost of your medication out-of-pocket, you and your doctor may decide that a lower-cost generic or brand alternative medication that is not part of the program is right for you. Your plan will provide benefits for medications included in the program when you first try a lower-cost medication or your doctor obtains prior authorization of coverage through BCBSIL.

Below are drug categories and specific medications* for which a step therapy program exists for most HMO members. Step therapy does not apply to the generic equivalents for these medications (if available). If you and your doctor decide the generic equivalent is an option for you, you will not need to go through the prior authorization process. Please note: These medications are listed along with the first use approved by the U.S. Food and Drug Administration, but may be prescribed for conditions other than those noted and would still be part of the step therapy program.

Please note that the drug categories and medications may change from time to time. For the most up-to-date list, call the Pharmacy Program number on the back of your BCBSIL ID card.

As always, cost is only one factor in choosing medication, and treatment decisions are between you and your doctor.

Cholesterol

• Advicor
• Altoprev
• Crestor
• Lescol
• Lescol XL
• Lipitor
• Mevacor
• Pravachol
• Simcor
• Vytorin
• Zetia
• Zocor

Hypertension (High Blood Pressure)

• Accupril
• Accuretic
• Aceon
• Altace
• Atacand
• Atacand HCT
• Avalide
• Avapro
• Azor
• Benicar
• Benicar HCT
• Capoten
• Capozide
• Cozaar
• Diovan
• Diovan HCT
• Exforge
• Exforge HCT
• Hyzaar
• Lotensin
• Lotensin HCT
• Mavik
• Micardis
• Micardis HCT
• Monopril
• Monopril HCT
• Prinivil
• Prinzide
• Tekturna
• Tekturna HCT
• Teveten
• Teveten HCT
• Uniretic
• Univasc
• Vaseretic
• Vasotec
• Zestoretic
• Zestril

Insomnia

• Ambien
• Ambien CR
• Edluar
• Lunesta
• Rozerem
• Sonata
• Zolpimist

Osteoporosis

• Actonel
• Actonel with calcium
• Boniva
• Fosamax
• Fosamax plus D

Proton Pump Inhibitors (contol acid production in the stomach)

• AcipHex
• Kapidex
• Nexium
• pantoprazole
• Prevacid
• Prilosec
• Protonix
• Zegerid

Rheumatoid Arthritis/Psoriasis

• Cimzia prefilled syringe
• Enbrel
• Humira
• Kineret
• Simponi

More information is available in the prior authorization program member brochure and step therapy program member brochure.

If you have questions about the prior authorization/step therapy program, call the Pharmacy Program number on the back of your BCBSIL ID card.

* Third-party brand names are the property of their respective owners.