For Providers: How Do I Submit Prior Authorization Requests for Drugs?

To help make sure Blue Cross Blue Shield of Michigan and Blue Care Network members receive the most appropriate and cost-effective therapy, we require providers to take additional steps before certain drugs are eligible for reimbursement. 

Prior authorization requirements

We require providers to request prior authorization for certain medicines, such as specialty drugs, to ensure certain clinical criteria are met.

Submitting prior authorization requests

For drugs that require prior authorization, providers should submit requests as follows:

Step therapy requirements

Step therapy requires that the member has tried an alternative therapy first, or that the prescriber has clinically documented why the member cannot take the alternative therapy. In some cases, step therapy requirements may require members to first try over-the-counter products.

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Related forms and documents

Prior Authorization and Step Therapy for Clinical, Custom and Custom Select Drug Lists (PDF)
Prior Authorization and Step Therapy Guidelines for Preferred Drug List (PDF)
Electronic Prior Authorization (PDF)
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