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September 2015

Preauthorization expansion to Medical Drug Utilization Management Program begins soon

Blue Cross Blue Shield of Michigan will soon be expanding its utilization management program to include medical drugs administered in hospital outpatient locations.

Prior authorization will be required for certain medical drugs, in order to be covered under a member’s medical benefits, when they’re administered in a hospital outpatient location.

You can find a current list of medications that require prior authorization, as well as a list of groups that have opted out, on web-DENIS:

  • Click on BCBSM Provider Publications and Resources.
  • Click on Commercial Pharmacy Prior Authorization and Step Therapy forms.
  • From this page, click on Pharmacy prior authorization/Step therapy forms link at the top of the page.
  • Click on Physician administered medications (on the right side under “Frequently used forms”).

We’ll provide additional details in The Record later this year.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
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