Blue Cross Complete (Medicaid)
Note: The Blues' Medicaid product changed its name from BlueCaid of Michigan to Blue Cross Complete effective April 1, 2012, but providers will see both the old and new names during the transition to Blue Cross Complete. New ID cards are being mailed to members in April, but both the old BlueCaid and the new Blue Cross Complete ID cards have the same numbers and can be used during the transition. Remember to check eligibility before providing services to the member.
The Blue Cross Complete of Michigan (formerly BlueCaid of Michigan) prescription drug program (PDF) identifies the basic terms of coverage for Blue Cross Complete members. When prescribing medications for Blue Cross Complete members, please refer to the Blue Cross Complete Preferred Drug List (PDF). Note that HIV/AIDS and most psychotropic drugs are covered by the Michigan Department of Community Health and are not payable through Blue Cross Complete. Refer to the complete list of these drugs: Michigan Department of Community Health - Health Plan Carve-Out (PDF).
Blue Cross Complete members can have their prescription filled at more than 2,000 retail pharmacies (PDF) throughout Michigan. Walgreens® Specialty Pharmacy, LLC handles mail-order prescriptions for specialty drugs (PDF). Members can also fill their specialty drug prescriptions at a University of Michigan Health System Pharmacy, or from a Blue Cross Complete-affiliated retail pharmacy.
If a medication requires step-therapy or prior authorization, you can request coverage for your Blue Cross Complete patient based on medical necessity. Generally, Blue Cross Complete will only approve your request for authorization if the alternative drugs on the Blue Cross Complete Preferred Drug List (PDF) would not be effective for the member or would cause the member to have adverse medical effects. You can refer to the Blue Cross Complete Pharmacy Prior Authorization Guidelines (PDF) to see which drugs require prior authorization and what the criteria are for each drug. You should direct requests for coverage for drugs provided through the Michigan Department of Community Health to Magellan at 1-877-624-5204.
There are two ways to request coverage:
- Contact the BCN Clinical Pharmacy Help Desk at 1-800-437-3803 to initiate a prior authorization request.
- Complete the Blue Cross Complete Prior Authorization Request form (PDF). Fax completed forms to the Clinical Pharmacy Help Desk at 1-877-442-3778. If you need to send an attachment, please fax the attachment with the form.