Medicaid

This information applies to Medicaid members who have Blue Cross Community CentennialSM 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).

Drug List

  • 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 
  • As of September 1, 2017, TRUEplus® and TechLITE® insulin pen needles will be the only covered insulin pen needles and TRUEplus® insulin syringes will be the only covered insulin syringes on the BCBSNM Medicaid formulary. Prescriptions for other brands will require prior authorization from BCBSNM. Plan members who are affected will be sent a letter in the mail letting them know of this change.

Forms

Prior Authorization

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

Specialty Pharmacy Program

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.


Such services are funded in part with the State of New Mexico.