Pharmacy Benefit Prior Authorization for Some FHP and ICP Members with ADHD

Posted January 13, 2017

Blue Cross Community Family Health Plan^SM (FHP) and Blue Cross Community Integrated Care Plan (ICP)^SM members under the age of 5 and over the age of 18 years old have been required since Oct. 1, 2016, to have a pharmacy benefit prior authorization (PA) before receiving medications for attention-deficit hyperactivity disorder (ADHD). 

If a provider was treating a member who had been on an ADHD medication 90 days prior to Oct. 1, 2016, the provider has until March 31, 2017, to submit a request for pharmacy benefit PA if the medication is going to be continued. Additionally, if a member turned 18 years old after Oct. 1, 2016, the provider must submit a pharmacy benefit PA before that member’s birthday for the member to continue receiving the medication. Members over the age of 18 and parents of members under the age of 5 were sent a letter in September 2016 explaining this benefit change. 

Providers may submit pharmacy benefit PA requests online via the CoverMyMeds^® site at covermymeds.com. While electronic options are preferred, pharmacy benefit PA requests also may be called in to 800-285-9426, followed by a statement with supporting documentation, which may be faxed to 877-243-6930, or mailed. 

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. 

Please note that 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.