October 5, 2023

Primary Formulary Step Therapy

Step Therapy is a program designed to encourage appropriate utilization of lowest‐net‐cost medications for chronic medical conditions, helping to control healthcare costs. Step Therapy is a series of steps or medications that must be tried in a specific order. We review the prescription claim history for specific
October 5, 2023

Specialty Clinical Consultation List

Specialty medications are medications that require special handling, personalized care, monitoring, or special delivery needs. These products, whether injectable or non‐injectable medications, require specialized clinical management
October 5, 2023

P&T Committee Changes

Effective 1/1/2024 As your Prescription Benefit Facilitator, BeneCard PBF is committed to providing the highest quality service, innovative clinical solutions, and valuable trend management strategies. BeneCard PBF controls trend through several factors
October 5, 2023

Drug Quantity Management Program

Medications may have a high risk of side effects or an adverse event when taken above the recommended FDA amount. To promote safe and appropriate use of such medications, BeneCard PBF has limits for how
October 5, 2023

Standard Clinical Review List

BeneCard PBF’s clinical review program utilizes online claim adjudication edits to prevent claim payment until BeneCard PBF has assessed the patient’s drug history and/or current diagnosis through communication with the member’s physicians to ensure appropriate and safe utilization of the medication. Drugs requiring clinical review are associated with a diagnosis-based drug utilization protocol that is used to determine coverage. These protocols are based on clinical information
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