June 2015
Reminder: four specialty drugs to be 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 under our members’ medical benefits.
The prior authorization is only a clinical review 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 medication request forms within the list of medications that require prior authorization on web-DENIS. 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 Blue Cross or a request uploaded onto the online-based tool, NovoLogix®. Standard processing time for review of a request is 15 days. An urgent request can be reviewed within 72 hours.
The following drugs will require prior authorization, beginning July 1, 2015:
Drug name |
HCPCS code |
Aveed® |
J3145 |
Delatestryl® |
J3121 |
Depo®-Testosterone |
J1071 |
Testopel® |
S0189 |
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. |