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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

View requirements for Local Plan and BlueCard Out-of-Area members.

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Pharmacy and Therapeutics Process

The Pharmacy and Therapeutics (P&T) process includes the selection of drugs considered to be the top choices based on their safety, effectiveness and value for our drug lists/formularies.   
The P&T process is led by an independent group of practicing doctors, pharmacists and other health care professionals responsible for the research and decisions surrounding our drug lists. This group meets regularly to review new and existing drugs, and to choose the top medications for our drug lists.  
The P&T process also helps improve customer health through programs like drug utilization review, promoting medication safety and encouraging compliance.   
Outcomes Based Drug Lists 
We offer Outcomes Based Drug Lists, which means we use a balanced approach to drug list management, based on a combination of research, clinical guidelines and member experience. 
Click the following link for information on the drug or drug class decisions made at a recent P&T Process meeting:   
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