Samsca (tolvaptan) - Medicaid

Prior Authorization, Quantity Limit

Hypoactive Sexual Desire Disorder (HSDD) - Commercial

Prior Authorization, Quantity Limit

Hyperhidrosis - Commercial

Prior Authorization, Quantity Limit

Fintepla - Medicaid

Prior Authorization, Quantity Limit

Fintepla (fenfluramine) - Commercial

Prior Authorization, Quantity Limit

Cannabidiol - Medicaid

Prior Authorization

Cannabidiol - Commercial

Prior Authorization

Blue Cross Blue Shield of Minnesota 2021 BasicRx Individual, Small Group $0 Insulin Member Cost-Share Drug List

Inpatient Admission Notification and Prior Authorization Request Form (PDF)

BC-COM-PharmProgPolicyNotifctn-Eff-1-1-22.pdf