If you go to a pharmacy to fill your prescription, it's most likely billed to your pharmacy coverage.
You can find out if a medication needs prior authorization by logging in to your account at bcbsm.com. You’ll need to know the name of the medication, the dosage and how often you’ll be taking it.
- After you've logged in, hover over My Coverage in the blue bar at the top of the page.
- Select Prescription Drugs from the drop down.
- Click the link, Price a drug and view additional benefit requirements. It will take you to Express Scripts®. You won't have to log in again.
- Enter the name of the drug and follow the instructions.
- You'll get an alert if the medication needs a coverage review—that's what Express Scripts calls prior authorization. Your doctor can ask for a coverage review by calling 1-800-437-3803.
You can also look on your plan’s drug list (a list of approved medications). On a regular drug list, if your medication has a PA after its name, you need to get prior authorization. Most plans also have a special list of drugs that need prior authorization.
Blue Cross Blue Shield of Michigan plans (Traditional and PPO)
Blue Care Network plans (HMO)
- Blue Care Network Custom Prior Authorization and Step Therapy Guidelines (PDF)
- Blue Care Network Comprehensive Prior Authorization and Step Therapy Guidelines (PDF)
Locate your plan on our Medicare drug list page. You'll be able to find your plan's prior authorization and step therapy guidelines there.