Blue Cross NC prior authorization criteria

Blue Cross NC reviews prior-authorization requests against its published medical policies — diagnosis with ICD-10 code, documented step-therapy history, and prescriber attestation of medical necessity. Standard PA decisions return in 30 days; if denied, prescribers and members have 180 days to appeal. Criteria by drug below.

Prior authorization criteria by drug

Each page covers Blue Cross NC's submission criteria, the documentation packet, and peer-to-peer prep for that drug.

• Adalimumab at Blue Cross NC →
• Aflibercept at Blue Cross NC →
• Apixaban at Blue Cross NC →
• Atezolizumab at Blue Cross NC →
• Atogepant at Blue Cross NC →
• Benralizumab at Blue Cross NC →
• Bevacizumab at Blue Cross NC →
• Bictegravir at Blue Cross NC →
• Buprenorphine at Blue Cross NC →
• Dapagliflozin at Blue Cross NC →
• Dulaglutide at Blue Cross NC →
• Dupilumab at Blue Cross NC →
• Eculizumab at Blue Cross NC →
• Elexacaftor Tezacaftor Ivacaftor at Blue Cross NC →
• Empagliflozin at Blue Cross NC →
• Erenumab at Blue Cross NC →
• Evolocumab at Blue Cross NC →
• Faricimab at Blue Cross NC →
• Fingolimod at Blue Cross NC →
• Fremanezumab at Blue Cross NC →
• Galcanezumab at Blue Cross NC →
• Glecaprevir Pibrentasvir at Blue Cross NC →
• Guselkumab at Blue Cross NC →
• Ibrutinib at Blue Cross NC →
• Imatinib at Blue Cross NC →
• Inclisiran at Blue Cross NC →
• Infliximab at Blue Cross NC →
• Ixekizumab at Blue Cross NC →
• Lenalidomide at Blue Cross NC →
• Liraglutide at Blue Cross NC →
• Lisdexamfetamine at Blue Cross NC →
• Mepolizumab at Blue Cross NC →
• Methylphenidate at Blue Cross NC →
• Naltrexone at Blue Cross NC →
• Natalizumab at Blue Cross NC →
• Nintedanib at Blue Cross NC →
• Nivolumab at Blue Cross NC →
• Nusinersen at Blue Cross NC →
• Ocrelizumab at Blue Cross NC →
• Ofatumumab at Blue Cross NC →
• Omalizumab at Blue Cross NC →
• Ozanimod at Blue Cross NC →
• Palbociclib at Blue Cross NC →
• Pembrolizumab at Blue Cross NC →
• Pirfenidone at Blue Cross NC →
• Ribociclib at Blue Cross NC →
• Rimegepant at Blue Cross NC →
• Risankizumab at Blue Cross NC →
• Rituximab at Blue Cross NC →
• Rivaroxaban at Blue Cross NC →
• Sacubitril Valsartan at Blue Cross NC →
• Secukinumab at Blue Cross NC →
• Semaglutide at Blue Cross NC →
• Sofosbuvir at Blue Cross NC →
• Tafamidis at Blue Cross NC →
• Tenofovir Alafenamide at Blue Cross NC →
• Tezepelumab at Blue Cross NC →
• Tirzepatide at Blue Cross NC →
• Tofacitinib at Blue Cross NC →
• Trastuzumab at Blue Cross NC →
• Upadacitinib at Blue Cross NC →
• Ustekinumab at Blue Cross NC →