Name of Manual - Blue Cross and Blue Shield of Minnesota

Formulary Exception
Process
(continued)
What steps should you take?
Coding Policies and Guidelines (Public Programs)
Determine which of your patients' current prescription drugs
written as DAW are not on the GenRx drug list. To determine
which drugs are on the GenRx formulary, visit
providers.bluecrossmn.com to view the list of drugs available to
Minnesota Health Care Programs members. Under the “Tools &
Resources” tab, choose “formulary and special program drug
lists.” Then click on “see the lists” under “Blue Cross formularies”
and select “GenRx.
What if a member tries to fill a DAW prescription for a drug
not listed in GenRx?
The prescription will not be filled by the pharmacy until the
certification or demonstration has been received and approved.
The member will be referred back to the prescribing physician for
a new prescription and/or a formulary exception submission on
their behalf.
Glucose Testing Meters The new GenRx drug formulary for MHCP members will include
only the Bayer CONTOUR and BREEZE 2 glucose testing meters
and strips. All other meters and test strips will be removed from
the drug list.
We are committed to helping you make this change and serving
these members' health care needs. If the patient and doctor can
show that a glucose meter other than the Bayer CONTOUR or
BREEZE is the best option for a member's treatment, the provider
can ask Blue Plus for a formulary exception. For assistance with
this, a member can call the member services number on the back
of the member ID card.
PCA Billing Claims for PCA services must be submitted to Blue Plus using one
date of service per claim line. Any claim lines that are submitted
with more than one date of service will be denied for improper
format. All claim lines should have an individual PCA associated
with the service.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (02/07/12)
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