Prior Authorization/Step Therapy Program

To help make sure our members receive the most appropriate and cost-effective therapy, some benefit plans require that additional steps be taken before certain drugs are covered. One or both of these steps may be required, depending on the drug:

  • Prior Authorization: Certain clinical criteria must be met before some drugs are covered. 
  • Step Therapy: Requires that the member has tried an alternative therapy first, or that their physician has clinically documented why they cannot take the alternative therapy. Step therapy may include select over-the-counter products. 

Which drugs require prior authorization or step therapy?

Drugs that require prior authorization or step therapy differ based on the drug list the member's plan uses:

How to request approval

Physicians can request approval one of four ways:

  • Online: Log in as a provider on bcbsm.com, then select "Pharmacy Benefit - Medication Prior Authorization"
  • Call: 1-800-437-3803
  • Fax: 1-866-601-4425
  • Write: Blue Cross Blue Shield of Michigan, Pharmacy Services, P.O. Box 2320, Detroit, MI 48231-2320

Questions? We can help!

To verify a member's benefit plan or get answers to your pharmacy-related questions, please contact us