How do I ask my plan to cover a prescription drug?

Who is this for?

pharmacy-icon

Blue Cross Blue Shield of Michigan and Blue Care Network members under age 65 with prescription drug coverage.

 

In most cases, your health insurance only covers or helps pay for prescription drugs included on your plan’s drug list.

We may not cover or help pay for some drugs even when they are on the list. That can happen if certain requirements aren’t met, like step therapy or prior authorization.

What if your doctor prescribes a drug not on the list? Or you or your doctor feels an exception should be made to requirements for a drug?

Requesting a review

Usually your doctor works with our pharmacy experts to find the safest, most effective and reasonably-priced drug your plan will cover or help pay for.

You can also contact us online and ask us to review a prescription:

  • PPO members should use the coverage request form. After we receive it, we'll contact your doctor about the prescription
  • HMO members should use this callback form. After we receive it, we'll contact you to help

When you can expect a response after our review

When it's an urgent request because of a life-threatening condition or situation, we make our decision within 24-72 hours.

In all other cases, we make our decision within 15 days.

Next steps

If your plan still won't cover or help pay for a drug after a review, you can file an appeal. Just follow these instructions. You'll need to know what kind of plan you have.