Feb. 20, 2025
Effective Jan. 1, 2025, we ended the requirement for prior authorization or step therapy for Food and Drug Administration-approved prescription drugs to treat an autoimmune disorder or cancer, except when a biosimilar, interchangeable biologic or generic version is available for some members.
This change applies to:
- Commercial fully insured employer-offered plans on the Performance Full Drug List
- Members with individual plans purchased on or off the New Mexico Health Insurance Exchange. Refer to our individual plan prescription drug lists.
- Turquoise Care members
- Plans sponsored by the State of New Mexico, New Mexico Public Schools Insurance Authority, Albuquerque Public Schools and the New Mexico Retiree Health Care Authority (Interagency Benefits Advisory Committee IBAC Plans)
Be sure to check eligibility and benefits via Availity® Essentials or your preferred electronic vendor prior to rendering services.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of New Mexico. BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.