These programs help our members pay less out-of-pocket on prescription drugs. They save money while continuing to receive the effective, high-quality medical care they count on.
This program encourages the use of the most cost effective drugs over the higher priced brand-name medications if a prescription for the targeted brand-name medication has not been filled in the last six months (180 days).
Program requirements are listed in the BCBSM Prior Authorization/Step Therapy Guidlines (PDF)
Off-Label / High-Cost Specialty Review Program
This program disallows coverage for drugs prescribed for uses other than those approved by the FDA and requires a prior authorization review of other high cost specialty drugs.
Program requirements are listed in the BCBSM Prior Authorization/Step Therapy Guidelines (PDF)
We'll encourage the use of specific prescription drugs in once-daily dosage regimens, as opposed to using lower multiple doses of the same drug.
Download a list of drugs included in the Dose Optimization Program (PDF)
This program calls for single-source brand-name drugs to be interchanged with less costly generic alternatives. Though some targeted medicines do not have a generic equivalent of their own, similar prescription drugs with a generic counterpart are available, thus creating the interchange.
Download a list of drugs included in the Brand-to-Alternate Generic Interchange Program (PDF)
Quantity Limit for Selected Drugs
We'll block the dispensing of targeted drugs in quantities that are inconsistent with their labeling.
- Custom Select Drug List Quantity Limit Program (PDF): Use this quantity limit chart for members in individual and small group plans that are new for 2014.
- Quantity Limit Program (PDF): Use this chart for all other Blue Cross Blue Shield of Michigan plans that include quantity limits. It lists our 30- and 90-day quantity limits for medications.
Generic Copay Waiver Program
We'll waive the first copay for a preferred generic drug when a member switches to the generic from the brand-name medication.
Download a sample list of drugs included in the Generic Copay Waiver Program (PDF)
Questions? We can help!
To verify a member's benefit plan or get answers to your pharmacy-related questions, please contact us.