Drugs added to the Medical Drug Prior Authorization Program, effective April 1, 2015

Beginning April 1, 2015, five additional specialty drugs administered by health care practitioners will require prior authorization from Blue Cross Blue Shield of Michigan before they will be covered under members’ medical benefits. The prior authorization is only a clinical review approval; it is not a guarantee of payment. Health care practitioners will need to verify the members’ coverage for medical benefits.   

This helps ensure proper use and address potential safety issues for these medications.

You can find medication request forms within the 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 authorization until we receive a physician-signed medication request form faxed or mailed to BCBSM or a request uploaded onto the online-based tool, NovoLogix. Standard processing time for review of a request is 15 days. An urgent request is reviewed within 72 hours.

The drugs in the following list** will require prior authorization starting April 1, 2015:

Note: The prior authorization requirement does not apply to Medicare, Medicare Advantage or Federal Employee Program^® members.

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