Updates to Medical Drug Prior Authorization Program take place Jan. 1

Beginning Jan. 1, 2015, there are 13 additional specialty drugs administered by health care practitioners that will require prior authorization by Blue Cross Blue Shield of Michigan before they will be covered under our members’ medical benefits.

This will help ensure proper utilization and address potential safety issues for these medications.

Note: The prior authorization only represents clinical review approval, and is not a guarantee of payment. Health care practitioners will still need to verify coverage for medical benefits. Also, the prior authorization requirement does not apply to Medicare, Medicare Advantage or Federal Employee Program^® members.

You can find the medication request forms and 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”).

We will not consider a request for coverage until a physician-signed medication request form has been faxed or mailed to Blue Cross or the request is uploaded onto the online-based tool, Novologix^®. Standard processing time for a review of a request is 15 days. An urgent request is reviewed within 72 hours.

The following drugs will require prior authorization, beginning Jan. 1, 2015:

The following two drugs will have a HCPCS code assigned at a later date.

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