Pharmacy utilization management

Information about Blue Cross and Blue Shield of Minnesota pharmacy utilization management programs

Below is a list of Blue Cross and Blue Shield of Minnesota and Blue Plus pharmacy benefit drug utilization management (UM) program summaries. The summary policies outline which drugs may require prior authorization, step therapy and/or quantity limits.

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Search by drug name, drug class or condition. While some pharmacy UM program criteria titles may include specific drug names, some titles may be for a group (or class) of drugs.

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Note: Not all employer groups retain Prime Therapeutics as their pharmacy benefits manager (PBM). The pharmacy policies content only applies to those employer groups who retain Prime Therapeutics. Member ID cards with RxBIN 610455 and RxPCN PGIGN or HMHS on the front indicate that a member has Prime Therapeutics as their PBM and these pharmacy policies apply.

Pharmacy UM Program Criteria Sort descending Program Type Program Effective Date Status
Substrate Reduction Therapy - Commercial Prior Authorization, Quantity Limit Active
Substrate Reduction Therapy - Medicaid Prior Authorization, Quantity Limit Active
Sucraid®
(sacrosidase) - Commercial
Prior Authorization, Quantity Limit Active
Sucraid®
(sacrosidase) - Medicaid
Prior Authorization, Quantity Limit Active
Sucralfate Suspension - Commercial Prior Authorization, Quantity Limit Active
Sunosi™ (solriamfetol) - Commercial Prior Authorization, Quantity Limit Active
Sunosi™ (solriamfetol) - Medicaid Prior Authorization, Quantity Limit Active
Symlin® (pramlintide) - Medicaid Step Therapy, Quantity Limit Active
Tarpeyo™ (budesonide) - Commercial Prior Authorization, Quantity Limit active
Tarpeyo™ (budesonide) - Medicaid Prior Authorization, Quantity Limit active