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Electronic Options for Pharmacy Benefit Prior Authorization (PA) Requests

Posted March 21, 2014

Blue Cross and Blue Shield of Illinois (BCBSIL) continues to enhance the process for submitting Pharmacy Prior Authorization (PA) benefit requests for drugs that are a part of our Pharmacy PA program. 

In our November 2013 Blue Review, we announced the availability of CoverMyMeds® for electronic completion and submission of PA requests for drugs that may be considered eligible for benefits under the member’s pharmacy benefit. A link to CoverMyMeds is available in the Pharmacy Program/Prior Authorization and Step Therapy Programs section of our website; a link is also available to registered users on the Availity® portal. CoverMyMeds is available for PA requests for members who have their pharmacy benefit administered by Prime Therapeutics; exclusions may apply. 

Now, you can also submit medical pharmacy PA requests online using iEXCHANGE® , our Web-based tool that accepts prior benefit authorization requests 24 hours a day, seven days a week.* In addition to PA requests for medical/surgical and behavioral health services, iEXCHANGE supports outpatient PA requests for the following specialty drugs, which may be considered eligible for benefits under the member’s medical benefit:

  • Avastin
  • Mybloc
  • Reclast
  • Botox
  • Remicade

Using online options for specialty drug PA requests replaces the need to fax paper forms to BCBSIL. It provides immediate confirmation upon receipt, without the need to resubmit requests or call to check status. 

Learn More About iEXCHANGE

For more about how to use iEXCHANGE or upcoming training opportunities, please consult the following resources: 

  • To get started using iEXCHANGE, new users can register by completing the online enrollment form found on the Provider Tools page. Upon completion, users will receive login information to access iEXCHANGE via the Provider login page. iEXCHANGE is also accessible to registered users via a “single sign-on” feature at availity.com .
  • For reference, a new Submitting an Outpatient Pharmacy Preauthorization Tip Sheet  is available on the Provider Tools page. This tip sheet offers step-by-step instructions for submitting a medical pharmacy PA request using the iEXCHANGE tool.
  • Additional training for iEXCHANGE is available upon request by contacting the iEXCHANGE training team at ProviderOutreachEducation@bcbsil.com.

Learn More About Our Pharmacy PA Program

Please be sure to visit the Prior Authorization and Step Therapy Programs page section for details and helpful resources. Also continue to check the News and Updates, as well as upcoming issues of the Blue Review for announcements on program enhancements related to pharmacy optimization and other important initiatives. 

Please note that the listing of any particular drug or classification of drugs and/or the fact that a service has been preauthorized/pre-certified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider. 

CoverMyMeds is a registered trademark of CoverMyMeds LLC, an independent third party vendor that is solely responsible for its products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions regarding the products or services they offer, you should contact the vendor(s) directly. 

Availity is a registered trademark of Availity, LLC. Availity is a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions about the products or services offered by such vendors, you should contact the vendors directly. 

Prime Therapeutics LLC is a pharmacy benefit management company. BCBSIL contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSIL, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. 

*With the exception of the third Sunday of every month when the system will be unavailable from 11 a.m. to 2 p.m. CT.

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