Additional specialty medical drugs require prior authorization starting March 1

Seven additional specialty drugs administered by health care practitioners will require prior authorization by BCBSM in order to be covered under members’ medical benefits, starting March 1.

Ensuring proper utilization and addressing the potential safety issues of these high-cost medications will address concerns that many of our major group customers have expressed.

You can find a list of medications that require prior authorization on web-DENIS:

• Click on BCBSM Provider Publications and Resources.
• Click on Commercial Pharmacy Prior Authorization and Step Therapy forms.
• Click on Physician administered medications (on the right side under Frequently Used Forms).

Criteria for authorization of these medications are included on web-DENIS. We will not consider a request for coverage until we receive either a physician-signed medication request or an online request through the NovoLogix tool. Requests will follow BCBSM time frames for coverage determination.

The following drugs will require prior authorization starting March 1, 2014:

Blue Cross Blue Shield of Michigan reserves the right to change this list at any time.

Please note that the prior authorization requirement does not apply to Medicare, Medicare Advantage or Federal Employee Program^® members.