This information applies to prescription drug coverage for Blue Cross and Blue Shield of New Mexico (BCBSNM) individual plans and employer-offered plans, as well as health plans offered on and off the New Mexico Health Insurance Exchange. BCBSNM plan members can check their benefit information to ensure they have prescription drug coverage with their specific health plan.
- Drug lists for BCBSNM commercial plans
- Drug lists for BCBSNM plans on/off the Exchange
- Medical Review Drugs and Criteria
Specialty Pharmacy Program
Visit the Specialty Pharmacy Program page for full information on the BCBSNM Specialty Pharmacy Program
See section 14.6 of the Blues Provider Reference Manual for a description of the Specialty Pharmacy Program, preauthorization requirements, split fill program, and additional specialty services.
Prior Authorization and Step Therapy
Prime Therapeutics, our pharmacy benefit manager, conducts all prior authorization and step therapy preauthorization requests from physicians for BCBSNM members with prescription drug coverage through Prime Therapeutics.
Dispensing (Quantity vs. Time) Limits
Dispensing limits help to minimize healthrisks and reduce overall costs. Learn mor