Four specialty drugs added to prior authorization program July 1

Beginning July 1, 2015, four additional specialty drugs administered by health care practitioners will require prior authorization by Blue Cross Blue Shield of Michigan before they are covered by BCBSM members’ medical benefits.

The prior authorization is only a clinical review and approval, not a guarantee of payment. Health care practitioners will need to verify the necessary coverage for medical benefits. These updates will help ensure proper drug use while addressing potential safety issues.

You can find the medication request forms on web-DENIS within the list of medications that require prior authorization. To access the forms:

• 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 tool, through NovoLogix^®. Standard processing time to review a request is 15 days. An urgent request can be reviewed within 72 hours.

Starting July 1, 2015, the following drugs will require prior authorization:

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

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