Updates to Medical Drug Prior Authorization Program taking place in July

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

The prior authorization is only a clinical review approval. A prior authorization approval isn’t a guarantee of payment. Health care practitioners will need to verify the necessary coverage for medical benefits.

This will help ensure proper utilization 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 won’t consider a request for coverage until we receive a physician-signed medication request form either faxed or mailed to Blue Cross or a request uploaded to 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 following drugs will require prior authorization starting July 1, 2015:

Blue Cross 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.