Medical drug preauthorization program
Capital’s medical plans include an innovative preauthorization program for drugs covered under the medical benefit that’s designed to guide the best possible care for our members while balancing cost to best serve our customers.
The medical drug preauthorization program is supported by a team of doctors who can provide an expert-level, evidence-based review for specific treatments. More specialized preauthorization reviews can mean better outcomes, reduced costs, and safer treatments. Here’s how:
- Higher safety and quality standards for your employees.
- Safe, appropriate coverage of complex, high-cost drugs.
- Reduced care costs.
- Site-of-service optimization.
- Care based on member’s health history and diagnosis.
What types of treatments are included in the program?
Medical drugs typically must be administered by a healthcare provider; examples include (but are not limited to) chemotherapy drugs, gene therapies, hemophilia infusion treatments, and infusions to treat autoimmune conditions.
Medical policies
Learn more about medical policies through Prime Therapeutics Management, LLC.
Contact your Capital Blue Cross account executive with any questions.
On behalf of Capital Blue Cross, Prime Medical Pharmacy Solutions (Prime MPS), a division of Prime Therapeutics Management LLC, provides medical specialty drug management services. Prime Therapeutics Management LLC is an independent company.