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Review clinical criteria and submit a prior authorization if necessary.

BMC HealthNet Plan members and providers can search the BMC HealthNet Plan Formulary for coverage of specific medications. If you feel it is medically necessary for a member to take a medication that’s not covered, please submit a prior authorization request.

  • If the request meets criteria, BMC HealthNet Plan will cover the drug.
  • If the request is denied, the member and the authorized appeal representative have the right to appeal the decision. 

Once you locate the drug, click the "More Info" link or the PA icon next to the drug to see the criteria and the form.

Please review clinical guidelines before submitting prior authorization requests. Be sure to provide complete information on the form.

Other Drug Exceptions

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