PPO Drug Lists for Group Members

Who is this for?

Michigan Health Insurance – Customer Service – Pharmacy

If you have a PPO health plan that includes prescription drug coverage through an employer, you can use these drug lists to see if your plan covers a medication.

Employers with more than 50 full-time employees can choose the prescription drug coverage that goes with the health plans they provide. So not all group PPO plans from Blue Cross Blue Shield of Michigan share the same drug list.

To see if a medication is covered, you'll need to know whether your plan uses Clinical, Custom or Custom Select drug lists. You can find out by checking your prescription drug benefits. If you can't find your drug list here, call the customer service number on the back of your Blues ID card and we'll help.

Some lists can be used with most of our group PPO plans. They're listed below under "Other helpful drug lists."

Clinical drug lists

  • Clinical Drug List (PDF)
  • Clinical Drug List Updates (PDF)

Custom drug lists

Use with triple-tier, five-tier or closed (managed) plans only.

A triple-tier plan has three fixed copays, one for each tier of drugs. A closed or managed plan only covers Tier 1 and Tier 2 drugs.

  • Custom Drug List (PDF)
  • Custom Drug List Quick Guide for Members (PDF)
  • Custom Drug List Updates (PDF)
  • Preferred Alternatives (PDF): If a drug you've been prescribed is a nonpreferred drug on our Custom Drug List, your doctor can use this list to find an alternative.

Custom Select drug lists

  • Custom Select Drug List (PDF)
  • Custom Select Drug List Quick Guide (PDF)
  • Custom Select Drug List Quantity Limit Program (PDF): A list of medications with 30- and 90-day quantity limits.
  • Custom Select Drug List Alternatives for Most Common Drug Exclusions (PDF): Use this list to find alternatives to drugs commonly excluded from the Custom Select Drug List.

Other helpful drug lists

Drug List Exclusions (PDF): A list of drugs that aren't covered on the commercial Blue Cross Blue Shield of Michigan drug lists. 

Preventive Drug Coverage (PDF): A list of preventive drugs that are covered with $0 copay.

Prior Authorization and Step Therapy Guidelines (PDF): A list of drugs that need to be approved before your plan will cover them.

Quantity Limit Program Drug List (PDF): A list of drugs that have 30- and 90-day quantity limits.

Specialty Drug Program Member Guide (PDF): A list of drugs used to treat complex and chronic illnesses that require special handling. The guide also includes the enrollment form for ordering specialty drugs from Walgreen's Specialty Pharmacy.

15-Day Specialty Drug Limitation Program List (PDF): A list of potent specialty drugs that have a 15-day supply limit.