Medicaid

This information applies to Medicaid members who have Blue Cross Community Centennial^SM prescription drug benefits. Prime Therapeutics is the Pharmacy Benefit Manager (PBM) that provides drug benefits through Blue Cross and Blue Shield of New Mexico (BCBSNM).

Lista de medicamentos

• Medicaid Drug List — includes information about generics, preauthorization, specialty pharmacy, step therapy, OTC products, dispensing limits; also lists drugs by therapeutic categories.
• Medical Review Drugs and Criteria – Medical Benefits
• TRUEplus^® and TechLITE^® insulin pen needles are the only covered insulin pen needles.TRUEplus^® insulin syringes are the only covered insulin syringes on the BCBSNM Medicaid formulary. Prescriptions for other brands will require prior authorization by BCBSNM.

Formularios

• Formulario de solicitud de autorización previa para medicamentos 
• Call 888-327-9791 for mail service order form faxing instructions or ePrescribe prescription order to EXPRESS SCRIPTS HOME DELIVERY
• Specialty Pharmacy General Use Fax Order Form
• Specialty Pharmacy Referral Forms by Therapy 
• Formulario de autorización previa de Synagis

Autorización previa

Physicians can access, complete, and submit prior authorization and step therapy request forms electronically from the CoverMyMeds^® website .

Prescription Exception Requests

Providers may submit coverage exception requests by fax to 1-877-243-6930, by phone at 1-800-285-9426 (TTY/TDD 711), or electronically on MyPrime.com  o CoverMyMeds^® website  Providers can find forms on MyPrime.com 

Programa de farmacias especializadas

Refer to Pharmacy Services in the Blue Cross Community Centennial section of the Blues Provider Reference Manual for a description of the Specialty Pharmacy Program, preauthorization requirements, and additional specialty services.

Related Resources:

• Submit an Electronic Prior Authorization Request 
• Uniform New Mexico HCV Checklist

_{Estos servicios están financiados en parte por el estado de Nuevo México.}