CommercialPrior AuthHigh impact
New Case Review Process for HIT Providers Dispensing Hemophilia Medications
CareFirst BlueCross BlueShield·Hematology·Provider News
Effective date
May 15, 2024
We identified it
Jun 20, 2026
Summary
Effective May 15, 2024, Home Infusion Therapy (HIT) providers must obtain prior authorization AND complete a case review process through CVS/Caremark before dispensing hemophilia medications for all CareFirst Commercial lines of business. This is a mandatory two-step process that will cause claim denials if not followed.
Action Required
By May 15, 2024: HIT providers must implement a mandatory two-step process for hemophilia medications: (1) Obtain prior authorization for all Commercial lines including CareFirst PPO, Indemnity, BlueChoice, HealthyBlue, NASCO, and BlueCard, and (2) Complete CVS/Caremark Hemophilia Case Review by faxing clinical data using the CVS/Caremark Hemophilia Case Review Form to 866-541-2934 before dispensing. Update billing workflows to ensure both steps are completed. Claims will be denied without proper authorization and case review completion.