If you need a prescription drug that is not covered by your outpatient prescription drug benefit, your physician or an authorized member of his or her staff may submit for prior authorization from Blue Shield.
For a prior authorization request to be considered for approval, a doctor would need to provide some clinical information about you such as your diagnosis, or medical reason why the preferred alternative(s) would not be appropriate for you.
The Blue Shield Pharmacy and Therapeutics Committee selects the drugs that require prior authorization and develops the coverage criteria for any drugs that require prior authorization.
Your Physician or Pharmacist may call or fax Blue Shield of California Pharmacy Services to request a prior authorization at the following times:
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Commercial Plans 8 a.m. to 5 p.m. Monday, Wednesday, Thursday & Friday (Tuesday 8 a.m. to 4 p.m.)
Medicare Plans 8 a.m. to 6 p.m. Monday through Friday.