Rx Management Programs

Prior Approval, Step Therapy, Quantity Limits


Overview

Drug costs are one of the biggest challenges to controlling health care costs. Blue Cross and Blue Shield of Vermont engages many tools to ensure members get the best possible medications at the best prices.

Program Components

ProgramDescriptionReference
Prior ApprovalSome newer, more expensive or frequently over-utilized drugs may require your provider to get advance approval.Formulary / Drug Lists
Step TherapyProviders should always try less expensive drugs before using the newest, most expensive drugs.
Quantity LimitsIf a prescription amount exceeds our criteria, your provider may need to provide documentation. 
This ensures safe and effective amounts of a drug while controlling waste or inappropriate use.

 

Updated: November 2016