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Prior Authorization & Step Therapy
Prior Authorization & Step Therapy

Safety is Our Priority
New drugs and new drug information come to the market at an astounding pace. Additionally, a record number of drugs have been taken off the market because of safety issues that were identified after marketing. In order to help assure our members have access to safe, effective drug therapy and to protect against inappropriate use and waste, we require prior authorization and step therapy* on selected prescription medications.

Prior Authorization & Step Therapy Requirements

Request Approval Online with Electronic Prior Auth (ePA)

You and your staff can request a coverage determination electronically, directly from your electronic medical record (EMR) or through CoverMyMeds ePA portal.

You can submit ePA to our Health Plan directly from your electronic health medical system (EMR) if that system has ePA capability. Many EMR systems now have ePA ability. Contact your EMR vendor for more information.

With CoverMyMeds, you can manage pharmacy prior authorizations for your patients with Excellus BCBS pharmacy benefits (as indicated on your patient's prescription insurance card).

With ePA:

  • You can submit requests for PA prospectively.
  • You can renew Prior Authorizations 60 days prior to expiration.
  • ePA through CoverMyMeds is free.
  • Any authorized personnel can use ePA

Visit for additional information on CoverMyMeds and electronic prior authorizations.

Request Approval by Fax or Eform

Use these links to access our Prior Authorization Fax Request Forms:

Send Coverage Determination Request via Secure Eform (sends to our FAX server)

* Step Therapy - In some cases, we require members to first try certain drugs to treat their medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat the medical condition, we may not cover Drug B unless the patient tries Drug A first. If Drug A does not work for the patient, we will then cover Drug B.