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Prime Pharmacy Program Summary Policies

Pharmacy policies are developed through consideration of peer reviewed medical literature, FDA approval status, accepted standards of medical practice in Montana, Prime Therapeutics evaluations, and the concept of medical necessity. BCBSMT reserves the right to make exceptions to policy that benefit the member when new medical information becomes available.

The purpose of pharmacy policy is to guide coverage decisions and is not intended to influence treatment decisions. Providers are expected to make treatment decisions based on their medical judgment. Blue Cross and Blue Shield of Montana welcomes provider feedback on all pharmacy policies.

When using a pharmacy policy to determine whether a medication will be covered, please note that member contract language will take precedence over policy when there is a conflict.

The Program Summary documents below open as a PDF file in a new window.  Specific fax forms are required for each authorization.

Physicians can access, complete and submit Prior Authorization and Step Therapy request forms electronically from the CoverMyMeds® website:

For more information on CoverMyMeds®, click here.

Or, download Prior Authorization and Step Therapy fax forms from the Prime Therapeutics website using the following links:

If you have questions or concerns regarding these programs, please call Prime Therapeutics at 888-723-7443. Click here for the Utilization Management Program overview document that will help you determine which prior authorization form is used for the medication being prescribed. 

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