Medicaid

This information applies to Medicaid members who have Medicaid prescription drug benefits. Prime Therapeutics is the Pharmacy Benefit Manager (PBM) that provides drug benefits through Blue Cross and Blue Shield of New Mexico (BCBSNM).

Drug List

• Medicaid Tobacco Cessation Program and Medication Formulary Information
• Medicaid Drug List — includes information about generics, preauthorization, specialty pharmacy, step therapy, OTC products, dispensing limits; also lists drugs by therapeutic categories.
• Medicaid Drug List Updates – list of quarterly updates being applied to the drug list.
• TRUEplus ® and TechLITE ® insulin pen needles are the only covered insulin pen needles. TRUEplus ® insulin syringes are the only covered insulin syringes on the BCBSNM Medicaid formulary. Prescriptions for other brands will require prior authorization by BCBSNM.
• Pharmacy Directory

Forms

• Drug Prior Authorization Request Form
• Call 888-327-9791 for mail service order form faxing instructions or ePrescribe prescription order to EXPRESS SCRIPTS HOME DELIVERY
• Specialty Pharmacy General Use Fax Order Form
• Specialty Pharmacy Referral Forms by Therapy
• Synagis Prior Authorization Form

Prior Authorization

Physicians can access, complete, and submit prior authorization and step therapy request forms electronically from the CoverMyMeds ® website.

Prescription Exception Requests

Providers may submit coverage exception requests by fax to 1-877-243-6930, by phone at 1-800-285-9426 (TTY/TDD 711), or electronically on MyPrime.com or CoverMyMeds ® website Providers can find forms on MyPrime.com

Specialty Pharmacy Program

Refer to Pharmacy Services in the Turquoise Care section of the Blues Provider Reference Manual for a description of the Specialty Pharmacy Program, preauthorization requirements, and additional specialty services.

Related Resources:

_{Such services are funded in part with the State of New Mexico.}

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