Browse by Topic

Browse by Plan Type

Other Help

Not finding what you need in this section for members and insurance shoppers? Check out our other help sections below.

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 51 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."

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 Select drug lists

Other helpful 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.

Preferred Alternatives (PDF): If a drug you've been prescribed isn't in our drug list, your doctor can use this list to find an alternative.

Was this content helpful?

Rate it

Submit >

One site. One stop.

Managing your health plan online
has never been easier. On the new bcbsm.com, all your account information is in one place and personalized, so it's more useful.
Even better, you can access it anytime, anywhere, from your mobile device.

I’d like to register

Log in to my account

©1996-2014 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.

State and Federal Privacy laws prohibit unauthorized access to Member's private information. Individuals attempting unauthorized access will be prosecuted.

Site Map  |  Feedback  |  Important Legal and Privacy Information

Explanation of Level A Conformance
Better Business Bureau Online Seal of Reliability